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Choledochal Cysts

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Surgical Diseases of the Pancreas and Biliary Tree

Abstract

Congenital dilatation of the bile duct(s), commonly known as a choledochal cyst, may affect the extrahepatic or intrahepatic bile ducts or both. It is frequently associated with an abnormal junction between the pancreatic and bile ducts, which allows reflux of pancreatic juice into the bile duct and predisposes to pancreatitis. Most patients present with abdominal pain and/or jaundice in childhood. The condition is more common in females and Oriental peoples. Potential complications of the malformation include cholangitis, cyst rupture, gallstones, pancreatic disease, secondary biliary cirrhosis and bile duct malignancy. In the common types of choledochal cyst, optimum management involves accurate imaging of the bile and pancreatic ducts and any associated pathology followed by radical excision of the extrahepatic bile ducts and reconstruction by wide hilar hepaticoenterostomy. Laparoscopic excision has become increasingly popular but the surgeon must be careful not to compromise definitive surgical treatment if a minimally invasive approach is used. Long-term follow up is required to detect late complications such as bilioenteric strictures and malignancy which are more likely to develop when the original excision and reconstruction was insufficiently radical or if the original bile duct pathology involved both the intrahepatic and extrahepatic bile ducts.

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Abbreviations

CBD:

Common bile duct

CC:

Choledochal cyst

CHD:

Common hepatic duct

ERCP:

Endoscopic retrograde cholangiopancreatography

GGT:

Gamma-glutamyltransferase

MRCP:

Magnetic resonance cholangiopancreatography

PBM:

Pancreaticobiliary malunion

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Authors and Affiliations

  1. Department of Paediatric Surgery, Wellington Hospital, Wellington, New Zealand

    Mark D. Stringer

  2. Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand

    Mark D. Stringer

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  1. Gastrointestinal Surgery, Medanta – The Medicity, Gurgaon, Haryana, India

    Savio George Barreto

  2. Professor of Surgery, HBP/Upper GI Surgeon, Auckland City Hospital, University of Auckland, Auckland, New Zealand

    John A. Windsor

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Stringer, M.D. (2018). Choledochal Cysts. In: Barreto, S., Windsor, J. (eds) Surgical Diseases of the Pancreas and Biliary Tree. Springer, Singapore. https://doi.org/10.1007/978-981-10-8755-4_5

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