Choledochal cyst

Choledochal cyst

Choledochal cyst

¤Congenital cyst occuring in CBD
¤ manifest by 1 - 2 yrs of age
¤ TODANI classification
 type 1 - fusiform dilatation of              CBD
  type 2- lateral saccular                   diverticuli of CBD
  type 3 - Dilatation of intraduodenal segment of CBD
 type4-   Dilatation of CBD + intrahepatic biliary dilatation.
 type5 multiple intrahepatic cyst
CLINICAL FEATURES -
1. Age - children within 1-2 yrs of age
2. Common in females
3. Abdominal distention due to large cyst & cyst palpated.
4. Slow progressive laundice, recurrent attacks with abdominal pain.

INVESTIGATION -
1.USG - confirm presence of abnormal cyst
2. MRI - reveal relation between bile duct & pancreatic duct.
3. ERCP

¤TREATMENT -
  -premalignant anomaly
excision of cyst & reconstruction is treatment of choice
Type1- excision of cyst followed by Roux-en-y-hepaticojejunostomy.
 Type 2- excision of diverticulum wit suturing of CBD.
 Type 3 - endoscopic sphincterntomy is adequate
  Type 4- difficult to treat. Treated by Lilly's technique. In this technique posterior wall of byst can be left, after removal of mucosa
COMPLICATIONS -
1. Recurrent cholangitis wit high grade fever
2. Rupture of cyst
3. CBD  stones
4. Carcinoma in cyst