Professional Documents
Culture Documents
• intraperitoneal rupture
• bleeding due to erosion into adjacent vessels
• portal hypertension
• secondary biliary cirrhosis due to prolonged
biliary obstruction and recurrent cholangitis.
• In addition, type III cysts can case gastric outlet
obstruction due to the obstruction of the
duodenal lumen or intussusception.
Investigation
• Transabdominal ultrasound
• Computed tomography
• CT cholangiogarphy
• Endoscopic ultrasound
• Intraductal ultrasound
• Endoscopic retrograde cholangiopancreatography
• Magnetic resonance cholangiopancreatography
Transabdominal ultrasound
• First imaging modality used for the evaluation
• Not detect type III and type V cysts.
• sensitivity of 71 to 97 %
• Sensitivity 73 - 100 %.
• less sensitive than direct cholangiography for
excluding obstruction.
• The data are variable with regard to its ability to
diagnose an abnormal pancreatobiliary junction.
[46-75%]
MRCP
Management
• In the past, some patients were treated with
internal drainage via a cystenterostomy
• Because of these complications, patients
requiring treatment now generally undergo
cyst excision with hepaticoenterostomy.
• In patients with ascending cholangitis require
treatment with antibiotics and drainage.
Drainage can often be obtained via ERCP or
percutaneous transhepatic cholangiography.
Treatment
For types I, II, and IV –
• Excision of the extrahepatic biliary tree - including
cholecystectomy, with a Roux-en-Y
hepaticojejunostomy are ideal.
• In some difficult case, some surgeons advocate leaving
posterior cyst wall intact with mucosectomy
Gallbladder
Choledochal Cyst
Hepaticojejunostomy Roux-en-Y
Complications
• Cholangitis
• Biliary stone formation
• Anastomotic stricture
• Residual debris in the intrahepatic bile ducts
• Intrahepatic bile duct dilatation
• Malignancy
Thank you for attention