The aetiology of choledochal cysts
is still unclear.
On surgical exploration a large bile-containing cyst was found, arising from the proximal aspect of the common bile duct, compatable with a type I choledochal cyst
Initially, we entertained the impression of a choledochal cyst
until the HIDA failed to show communication into the cystic area.
Intra-operatively our case posed to be a choledochal cyst
(CC) was the second most frequent biliary indication for ERCP in our study population.
KEY WORDS: Choledochal cyst
, Bile duct, Carcinoma, Malignant change, Malignancy.
Regarding choledochal cysts
, choose one false answer:
Both were difficult to differentiate from a type 1 choledochal cyst
on clinical grounds and presented difficult surgical decision making.
of cases (total 40) Idiopathic neonatal hepatits 20 CMV hepatitis 06 PFIC 03 PILBD 03 Choledochal cyst
02 Galactosemia 02 Tyrosinemia 02 Sepsis 02 Table 3: Triangular cord sign in BA and non BA group Biliary Atresia Non biliary atresia Triangular cord sign group (n=25) group (n=40) TC sign >4mm 20 01 TC sign <4mm 05 39 Table 4: HIDA scan in BA and non BA group Biliary atresia Non biliary atresia HIDA Scan group (n=25) group (n=40) Non-excretory (positive) 25 16 Excretory (negative) 0 24 Table 5: correlation of fibrosis score with TC sign Fibrosis score TC sign >4 mm TC sign <4mm Fibrosis score >3 18 01 Fibrosis score <3 02 04
In a review of Japanese clinical literature by Yamashita et al, the investigators found cholelithiasis in 28% of cases, a choledochal cyst
in 11% cases, AUPBD in 30% cases and cancer in 26% cases (2).
An association with congenital abnormalities of the biliary tree, such as a choledochal cyst
or Caroli disease, and with polyposis cull and ulcerative colitis has previously been reported.
Due to the close proximity of intramural cysts in the bowel to surrounding structures such as the liver, the differential diagnosis may also include hepatic cyst and choledochal cyst
Choledocholithiasis was verified and a large choledochal cyst
(approximately 5 cm in size) stretching throughout the entire duodenal bend behind the head of the pancreas was found.
Pancreatic involvement before choledochal cyst
operation might be a risk factor for postoperative pancreatitis.
Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst
excision when the patients recovered from delivery.