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- Choledochal cysts are congenital dilations of the biliary tree.
- They may occur in any bile duct but characteristically involve the common hepatic duct and common bile duct. They are more frequently identified in women (3:1 ratio) and those of Asian descent.
- Sixty percent are diagnosed in patients under the age of 10 years.
- Diagnosis and treatment are essential because the cysts predispose to jaundice, choledocholithiasis, cholangitis, portal hypertension, and cholangiocarcinoma.
A classification scheme has identified five distinct types.
- Type I cysts are fusiform dilations of the common bile duct and are by far the most common (65% to 90%).
- Type II cysts are rare, isolated saccular diverticula of the common bile duct.
- Type III cysts, also termed choledochoceles, are localized dilations within the intraduodenal part of the common bile duct. Most lesions thought to be choledochoceles are in fact duodenal duplications.
- Type IV cysts are characterized by multiple cystic areas of the biliary tract, both inside and outside of the liver. Finally,
- type V cysts are single or multiple lesions based only in the intrahepatic portion of the tract (Caroli disease).for choledochal cysts surgery in Bangalore
Diagnosis 0f choledochal cysts
- The classic triad of right upper quadrant pain, jaundice, and a palpable abdominal mass is present only a minority of the time. Pain may mimic biliary colic.
- Neonates frequently present with biliary obstruction, whereas older youths suffer from jaundice and abdominal pain.
- Rarely, pancreatitis or duodenal obstruction can be caused by a choledochocele.
- Cirrhosis, sepsis from cholangitis, or free intraperitoneal rupture occur infrequently as late complications for choledochal cysts surgery in Bangalore.
Tests for choledochal cysts
Treatment – Choledochal cysts surgery in Bangalore
- Treatment is primarily surgical, as medical therapies are not successful. Cholangiocarcinoma develops in up to 30% of cysts and usually presents in the fourth decade of life.
Cyst excision with a Roux-en-Y hepaticojejunostomy reconstruction is the treatment of choice for types I and IV. Simple excision of the rare type II cyst has been performed.
Local cyst excision with sphincteroplasty through a transduodenal approach is effective for type III disease.
Endoscopic excision is now being evaluated.
Caroli disease can be treated with hemihepatectomy when confined to one side of the intrahepatic tract. More often, bilateral disease is present with associated liver damage and mandates orthotopic liver transplantation for choledochal cysts surgery in Bangalore