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| 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
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