Congenital Choledochal Malformation: Not Just a Problem for Children

Abstract

Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.

Type I choledochal cyst: A single institution study

“…[6] The incidence of CCs was reported to be <1 in 13,000 to 2 million population. [4,7] Incidence in India is not available, except for one large series of 79 cases from West Bengal, India.…”

“…Thus, Type Ic refers to a classical cystic malformation while Type If describes a more fusiform appearance. [6] Table 2 compares our cases in children with Mishra et al [13] Table 3 compares our adult cases with Maheshwari P. [1] Management of CC depends on the type of cyst. [16] Currently, complete cyst excision with RYHJ is widely accepted as the standard method of treatment for most CC [17] and is the treatment of choice in Type I.…”

“…CCs were classified based on King's College hospital classification of choledochal malformation. [6] …”

Effectiveness of extracorporeal shock wave lithotripsy on intrahepatic biliary calculi developing after choledochal cyst surgery: A case report

“…The development of intra-and extrahepatic bile duct stones has been reported as one of the most serious complications following choledochal cyst excision (3,4,(6)(7)(8). ESWL, which is performed without laparotomy or puncture, is a less invasive, novel technique, which uses shock waves to fragment calculi.…”

Choledochal Cyst: A Report of 3 Cases and a Review of its Treatment and Outcome

“…The less frequent ones are the types that usually present asymptomatic [31,32]. They include choledochal diverticulum, choledochocele and the Caroli's disease.…”