Choledochal Cyst

Excerpt

A choledochal cyst (CC) has traditionally been considered as a cystic dilation of the extrahepatic bile duct. Choledochal cysts are now termed biliary cysts to include intrahepatic cysts also. Biliary cysts are defined as cystic dilations involving the biliary tree at single or multiple segments of both the extrahepatic as well as intrahepatic bile ducts. In 1959 Alonso-LEJ et al. were the first to classify CC into 3 types based on the site of the biliary duct dilation. It was not until 1977 when Todani et al. modified the latter classification by adding 2 types of CCs. This five-category classification is the most commonly used by clinicians today; however, it is in dispute by some experts who claim that each type of CC has its natural course, complications, and management. It is proposed that a classification that focuses more on the pathogenesis rather than the simple anatomy of the biliary tree is recommended.

Choledochal cyst is a rare anomaly that is, at times, considered a premalignant condition, which often poses a diagnostic dilemma. The typical presentation of this condition is non-specific. Healthcare teams must have a high clinical suspicion of choledochal cysts while investigating patients with jaundice, abdominal pain, and palpable abdominal mass. Due to the vague nature of these symptoms and physical findings, proper imaging studies are crucial for its diagnosis. Excision of the CC has shown excellent results with an 89% event-free rate and an overall 5-year survival rate above 90%. Hence early diagnosis and appropriate management are needed for optimal results and good prognosis.