Choledochal cysts are congenital dilations of the biliary tree, more common in Asia with an incidence of 1 in 1000 hospital admissions. They are classified into several types based on their location and characteristics, with presentations including obstructive jaundice, abdominal pain, and complications like pancreatitis and biliary cirrhosis. Treatment varies by type, ranging from cyst excision and reconstruction to liver transplantation.

1. CHOLEDOCHAL CYSTS
V.S.S.M.ROHITH KUMAR
FINAL YR MBBS

2. DEFINITION
• ISOLATED/ FOCAL or COMBINED/DIFFUSE congenital
dialation of extra or intrahepatic biliary tree.
• More common in asia. Its incidence is 1 in 1000 hospital
admissions.

3. • Type I : Dilation of extraheoatic
biliary tree (60%)
• type Ia -cystic
• type Ib -focal segmental
• type Ic -fusiform
• Type II : Diverticulum of
extrahepatic biliary tree (5%)
• Type III :Choledochocele-cystic
dilation of intraduodenal part of
CBD(5%)
TYPES OF CHOLEDOCHAL CYSTS
( Todani Modification of Alonso-Lej Classification )

4. • Type IV : Dilatation of extra and
intrahepatic or multiple parts of
extrahepatic biliary tree (30%)
• type IV a : Dilatation of
extrahepatic and intrahepatic
biliary tree .It is 2nd most
common type.
• type IV b : Dilatation of multiple
sections of the extrahepatic bile
duct
• Type V : Dilatation of the only
intrahepaticbiliary tree (caroli’s
disease)
• Type VI :Cystic dilatation of cystic
duct

5. PRESENTATIONS
• common in females
• obstructive jaundice (80%)
• pain in right hypochondrium
• mass per abdomen(30%)
• failure to thrive
• TRAID OF CHOLEDOCHAL CYST
RIGHT UPPER QUADRANT PAIN
PALPABLE ABDOMINAL MASS
JAUNDICE

6. COMPLICATIONS
• Pancreatitis
• suppurative cholangitis
• Gall stone and CBD stone formation
• Biliary cirrhosis
• Rupture of cyst and peritonitis
• Cholangiocarcinoma in CBD
• Malignancy is common in posterior wall

7. INVESTIGATIONS
 US abdomen
 CT scan
 hepatobiliary nuclide scanning
 ERCP(endoscopic retrograde cholangiopancreatography) , CHOLANGIOGRAPHY-
to see ductal anatomy
 MRCP(Magnetic Resonance Cholangiopancreatography) status of pancreatic and
biliary system and pancreaticobiliary maljunction
 Liver function tests
 PTC (percutaneous transhepatic cholangiography)to see intrahepatic biliary tree

9. TREATMENT
In type I : excision of cyst with its mucosa and reconstruction by Roux-en-Y
hepaticojejunostomy
In type II : excision of diverticulum and suturing of CBD wall
In type III : Endoscopic sphincterotomy
In type IV a , V : Liver transplant
In type IV b :portoenterostomy