Management Dilemmas With Choledochal Cysts

Metcalfe, Matthew S.; Wemyss‐Holden, Simon A.; Maddern, Guy J.

doi:10.1001/archsurg.138.3.333

Cited by 78 publications

(63 citation statements)

References 107 publications

(124 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Preoperative diagnosis is very important as choledochal cysts with only extrahepatic duct involvement are managed by complete excision of cyst with hepaticoenterostomy and cholecystectomy, while if there is intrahepatic involvement then partial hepatectomy or liver transplantation may be needed according to the extent of disease [8,9]. As the use of laparoscopic management of CDC is increasing [10], preoperative diagnosis of such variants helps in deciding the surgical approach and to avoid complications of duct injury.…”

Section: Discussionmentioning

confidence: 99%

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

Gupta

Rajesh

Agrawal

et al. 2015

JCDR

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

Gupta

Rajesh

Agrawal

et al. 2015

JCDR

View full text Add to dashboard Cite

“…4e6 Abnormal function of the sphincter of Oddi has been reported to predispose to pancreatic reflux into the biliary tree and an association has been seen with increased sphincter of Oddi pressures and spasm. 6 Inadequate autonomic innervations: Kusunoki et al demonstrated suboptimal number of ganglion cells in the narrow portion if the common bile duct in patients with a choledochal cyst, as compared with controls suggesting a functional obstruction. 7,8 If choledochal cysts are not resected, a high incidence (20%e30%) of cholangiocarcinoma has been reported, mainly after the second decade of life, 8 which formed the basis of resection as state of the art surgical treatment.…”

Section: Aetiopathologymentioning

confidence: 99%

“…This policy is further supported by a study that found increasing rate of premalignant changes in resected cysts with advancing age. 6 …”

Section: Aetiopathologymentioning

confidence: 99%

“…6 Two-thirds the cases are diagnosed before the age of 10 years and 85% cases before puberty. Cystic dilatation of the extrahepatic tree can be diagnosed using ultrasound as early as 15 weeks of gestation e a half of these would continue to be asymptomatic in early infancy with the other half presenting with jaundice and a palpable mass.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…6 The surgical options available in the event of a difficult cyst following recurrent cholangitis, pancreatitis or spontaneous cyst perforation-peritonitis, where the planes of surgical dissection will be obscured, are: All of these have a significant residual risk of malignancy from the remnant part of the duct which after a radical cyst excision and reconstruction is 0.7% only. 18 Postoperatively patients undergo annual hepatobiliary ultrasound and liver function tests.…”

Section: Management Optionsmentioning

confidence: 99%

See 2 more Smart Citations

Choledochal cyst

Kumar

Rajagopalan

2012

Medical Journal Armed Forces India

View full text Add to dashboard Cite

Congenital Choledochal Cysts in Adults

Visser¹

2004

Arch Surg

156

148

View full text Add to dashboard Cite

Hypothesis: Excision of the extrahepatic portion of congenital choledochal cysts (CCs) avoids the risk of cancer. The standard classification scheme is out of date. Design: Retrospective case series and literature review. Setting: Tertiary care university hospital. Patients: Thirty-eight adult patients diagnosed as having CC from 1990 to 2004. Main Outcome Measures: Clinical and radiographic imaging findings, operative treatment, pathologic features, and clinical outcome. Results: Thirty-nine adult patients were treated for CCs (mean [SD] age at diagnosis, 31 [17] years, and mean [SD] age at surgery 37 [14] years). The primary report was abdominal pain (36 of 39 patients). Eight patients had cholangitis, 5 had jaundice, and 6 had pancreatitis. Radiographic imaging studies and operative findings showed that the abnormality predominantly involved the extrahepatic bile duct in 30 patients, the intrahepatic and extrahepatic bile ducts in 7 patients; and 2 were diverticula attached to the common bile duct. Surgical treatment in 29 (90%) of 31 patients with benign cysts (regardless of intrahepatic changes) consisted of resection of the enlarged extrahepatic bile duct and gallbladder and Roux-en-Y hepaticojejunostomy. Eight patients (21%) were initially seen with associated cancer (cholangiocarcinoma of the extrahepatic duct in 6; gallbladder cancer in 2). Seven of 8 patients had a prior diagnosis of CC but had undergone a drainage operation (3 patients), expectant treatment (3 patients), or incomplete excision (1patient). In none of the patients with cancer was surgery not curative. Nine patients had previously undergone a cystoduodenostomy and/or cystojejunostomy as children. Four of them had cancer on presentation as adults. There were no postoperative deaths. Cancer subsequently developed in no patient whose benign extrahepatic cyst was excised, regardless of the extent of enlargement of the intrahepatic bile duct. Conclusions: Congenital CCs consist principally of congenital dilation of the extrahepatic bile duct with a variable amount of intrahepatic involvement. We believe that the standard classification scheme is confusing, unsupported by evidence, misleading, and serves no purpose. The distinction between type I and type IV CCs has to be arbitrary, for the intrahepatic ducts were never completely normal. Although Caroli disease may resemble CCs morphologically, with respect to cause and clinical course, the 2 are unrelated. The other rare anomalies (gallbladderlike diverticula; choledochocele) are also unrelated to CC. Therefore, the term "congential choledochal cyst" should be exclusively reserved for congenital dilation of the extrahepatic and intrahepatic bile ducts apart from Caroli disease, and the other conditions should be referred to by their names, for example, choledochocele, and should no longer be thought of as subtypes of CC. Our data demonstrate once again a persistent tendency to recommend expectant treatment in patients without symptoms and the extreme risk of nonexcisional treatment. The entir...

show abstract

Management Dilemmas With Choledochal Cysts

Cited by 78 publications

References 107 publications

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

Choledochal cyst

Congenital Choledochal Cysts in Adults

Contact Info

Product

Resources

About