Choledochal cysts

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Choledochal cysts
Other namesBile duct cyst
Choledochal cysts.svg
Different types of choledochal cysts
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg

Choledochal cysts (a.k.a. bile duct cyst) are congenital conditions involving cystic dilatation of bile ducts. [1] They are uncommon in western countries [2] but not as rare in East Asian nations like Japan and China.

Contents

Signs and symptoms

Most patients have symptoms in the first year of life. It is rare for symptoms to be undetected until adulthood, and usually adults have associated complications. The classic triad of intermittent abdominal pain, jaundice, and a right upper quadrant abdominal mass is found only in minority of patients.[ citation needed ]

In infants, choledochal cysts usually lead to obstruction of the bile ducts and retention of bile. This leads to jaundice and an enlarged liver. If the obstruction is not relieved, permanent damage may occur to the liver - scarring and cirrhosis - with the signs of portal hypertension (obstruction to the flow of blood through the liver) and ascites (fluid accumulation in the abdomen). There is an increased risk of cancer in the wall of the cyst.[ citation needed ]

In older individuals, choledochal cysts are more likely to cause abdominal pain and intermittent episodes of jaundice and occasionally cholangitis (inflammation within the bile ducts caused by the spread of bacteria from the intestine into the bile ducts). Inflammation of the pancreas also may occur. The cause of these complications may be related to either abnormal flow of bile within the ducts or the presence of gallstones.[ citation needed ]

Diagnosis

Types

They were classified into 5 types by Todani in 1977. [3]

Classification was based on site of the cyst or dilatation. Type I to IV has been subtyped.

Treatment

Choledochal cysts are treated by surgical excision of the cyst with the formation of a roux-en-Y anastomosis hepaticojejunostomy/ choledochojejunostomy to the biliary duct. Future complications include cholangitis and a 2% risk of malignancy, which may develop in any part of the biliary tree. A recent article published in the Journal of Surgery suggested that choledochal cysts could also be treated with single-incision laparoscopic hepaticojejunostomy with comparable results and less scarring. In cases of saccular type of cyst, excision and placement of T-shaped tube is done.[ citation needed ] The first peroral endoscopic resection of a choledochal cyst ( typ lll, choledochocele ) was performed by Deyhle in 1973. ( Deutsche medizinidche Wochenschrift 99, 71 - 72 especially 83 - 83, Januar 1974 ).

Currently, there is no accepted indication for fetal intervention in the management of prenatally suspected choledochal cysts. [6] [7]

References

  1. "choledochal cyst" at Dorland's Medical Dictionary
  2. Liu YB, Wang JW, Devkota KR, et al. (2007). "Congenital choledochal cysts in adults: twenty-five-year experience". Chin. Med. J. 120 (16): 1404–7. doi: 10.1097/00029330-200708020-00005 . PMID   17825168.
  3. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K (1977). "Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst". Am. J. Surg. 134 (2): 263–9. doi:10.1016/0002-9610(77)90359-2. PMID   889044.
  4. "Biliary cysts". www.uptodate.com. Retrieved 2015-12-06.
  5. Conway, William C.; Telian, Simon H.; Wasif, Nabil; Gagandeep, Singh (2009). "Type VI biliary cyst: Report of a case". Surgery Today. 39 (1): 77–79. doi:10.1007/s00595-008-3789-4. PMID   19132475. S2CID   6096912.
  6. Coran AG, et al., eds. Pediatric Surgery. 7th ed. Philadelphia: Elsevier Saunders; 2012. Gonzales KD, Lee H. Chapter 106: Choledochal Cyst [Prenatal Diagnosis].
  7. Diao M, Li L, Li Q, Ye M, Cheng W (Jul 2013). "Single-incision versus conventional laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts: a case-control study". World J Surg. 37 (7): 1707–13. doi:10.1007/s00268-013-2012-y. PMID   23539195. S2CID   10317608.