Choledochal Cyst (Disease of Gallbladder)

The Todani classification system categorizes choledochal cysts into five main types

• Type I: Most common, involving saccular or fusiform dilation of the common bile duct
• Type II: Diverticulum (pouch-like outpouching) of the common bile duct
• Type III: Also known as choledochocele, a cystic dilation in the duodenal portion of the common bile duct
• Type IV: Multiple cysts; Type IVa involves both intrahepatic and extrahepatic bile ducts, while Type IVb involves only extrahepatic ducts
• Type V: Cystic dilatation of intrahepatic bile ducts, known as Caroli’s disease

Symptoms of choledochal cysts can vary based on the cyst’s type and size. Common signs include

• Abdominal pain, particularly in the upper right quadrant
• Jaundice (yellowing of the skin and eyes)
• Fever and chills, indicating possible infection
• Nausea and vomiting
• Enlarged liver (hepatomegaly) or palpable mass in the abdomen

Diagnosis typically involves imaging studies to visualize the bile duct:

• MRI with MRCP (Magnetic Resonance Cholangiopancreatography) Preferred method for detailed imaging of the biliary tre.
• Ultrasound May reveal cystic structures; however, MRCP provides more comprehensive detail.
• CT Scan Used in some cases for further evaluatio.

Surgical intervention is the primary treatment for choledochal cyst:

• Cyst Excision Complete removal of the cyst is recommende.
• Biliary Reconstruction Re-establishing bile flow by connecting the remaining bile duct to the small intestine, often using a Roux-en-Y hepaticojejunostom.
• Laparoscopic or Robotic Surgery Minimally invasive techniques that offer benefits like reduced pain, shorter hospital stays, and quicker recover. Early diagnosis and surgical treatment are crucial to prevent complications such as liver cirrhosis, cholangitis (bile duct infection), or an increased risk of bile duct cancer .