A choledochocele is a cystic dilation of the distal common bile duct (CBD). It corresponds to a type 3 choledochal cyst in the classification by Todani et al1 and is extremely rare. 2. The diagnosis is challenging and rarely made before surgery, as the presenting symptoms vary wildly and are nonspecific.
What is the most common type of choledochal cyst?
Type I cysts (see image below) are the most common and represent 80-90% of choledochal cysts. They consist of saccular or fusiform dilatations of the common bile duct, which involve either a segment of the duct or the entire duct. They do not involve the intrahepatic bile ducts.
What is fusiform dilatation of CBD?
Type I cysts are a dilatation of the extrahepatic bile duct. They are the most common type and seen in 75–85% of cases [7, 8]. Type I cysts may be further classified as cystic (IA), focal (IB) or fusiform (IC). The type II cyst is diverticulum of the common bile duct.
How does choledochal cyst cause jaundice?
In infants, choledochal cysts usually lead to obstruction of the bile ducts and retention of bile. This leads to jaundice and an enlarged liver.
What are the symptoms of bile duct problems?
Symptoms
- Abdominal pain in the upper right side.
- Dark urine.
- Fever.
- Itching.
- Jaundice (yellow skin color)
- Nausea and vomiting.
- Pale-colored stools.
When does a choledochal cyst need surgery?
Children with choledochal cysts need surgery to remove them. This involves removing a lobe of the liver if the cysts are intrahepatic, or part of the duct outside of the liver if the cysts are located there. This surgery also includes biliary reconstruction using a piece of intestine.
Is a choledochal cyst life threatening?
Choledochal cysts (CCs), which are cysts that can occur anywhere along the biliary tree, can cause clinically important mortality and morbidity unless diagnosed early.
What is cystic dilatation?
Choledochal cysts, are rare congenital dilations (enlargements) of the bile ducts, a network of long tube-like structures that carry bile from the liver to small intestine for digestion. Biliary System. Choledochal cysts are classified into 5 types, based on site of the cyst or dilatation.
Is choledochal cyst curable?
The treatment of choice for choledochal cysts is complete excision of the cyst with construction of a biliary-enteric anastomosis to restore continuity with the gastrointestinal tract.
What are choledochoceles and what causes them?
Choledochoceles refer to a specific type of choledochal cyst (type III under the Todani classification system ). In this type, there is dilatation of the intramural portion of the distal common bile duct within the duodenal wall. Its precise etiology is not clear 3 .
What are the treatment options for choledochocele?
When a choledochocele is small and symptomatic, it may be treated with an endoscopic sphincterotomy. Larger cysts are often removed by a surgical cystoduodenostomy. A 45-year-old man presented with a history of repeated postprandial vomiting. A barium meal was performed.
What is the Todani classification of choledochal cysts?
Todani Classification of Choledochal Cyst 1 Extrahepatic bile duct – Most common (77-87%) 2 Extrahepatic bile duct diverticulum. 3 Choledochocele. 4 Multiple cysts – Intra / extra. IVA – BOTH Intra and extrahepatic bile duct cysts. IVB: Only extrahepatic bile duct… 5 Only intrahepatic bile duct dilatation (Caroli’s disease). More
What is the prevalence of cholecholedochal cysts?
Choledochal cysts are rare, with an incidence of 1:100,000-150,000. Although they may be discovered at any age, 60% are diagnosed before the age of 10 years 1. There is a strong female predilection with M:F ratio of 1:4.
