Choledochal Cyst
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Transcript of Choledochal Cyst
Choledochal CystFrans
Definition
•Cyst of the choledocal duct•Approximately 1 in 10.000-13.000 live
births•More common in women (3-4:1)•More common in Asian (up to 1:1000) ,
especially in Japan
Etiology
• Long common channel of the terminal bile duct and pancreatic duct (more than 1 cm from the sphincter)• Reflux of the pancreatic enzyms• Possible genetic influence, common with
other anomalies (congenital hepatic fibrosis, intrahepatic biliary cysts, and polycystic kidney disease)• Possible congenital duct wall anomaly
Etiology (2)• Weakness of the wall of the bile duct (Babbitt,
1973; Bismuth, 1999; Flanigan, 1975)• Obstruction of the distal choledochus (Spitz,
1977)• Combination of obstruction and weakness
(Kato, 1974)• Reflux of pancreatic enzymes into the CBD
secondary to an anomaly of the pancreaticobiliary junction (Babbitt, 1969; Kato, 1981; Miyano, 1979; Okada, 1990; Todani, 1984, Yamashiro, 1984)
Etiology (3)
Clinical Presentation
•Jaundice •Pain in RUQ•Mass (rare)
Todani Classification• Type I - Cystic or fusiform dilatation of the CBD;
most frequent type (90-95% of the cases).• Type II - Diverticulum of the CBD, with normal size
CBD• Type III - Choledochocele, a cystic dilatation of the
distal intramural portion of the CBD, typically protruding into the second portion of the duodenum
• Type IV - Cystic or fusiform dilatation of the CBD associated with cystic, fusiform, or saccular dilatation of intrahepatic bile ducts, also termed form fruste
• Type V - Cystic, fusiform, or saccular dilatation of the intrahepatic bile ducts associated with a normal CBD; may be associated with hepatic fibrosis (referred to as Caroli disease)
Type
Radiology
TherapyType I-IV• Cystojejunostomy • Total Excision and Cystojejunostomy• Biliary reconstruction can be performed with a
Roux-en-Y hepaticojejunostomy as high as possible, near the hilum of the liver (Hata, 1993; Joseph, 1990; Kasai, 1970; Miyano, 1996)
Type V• Hepatic Lobectomy
Lilly Technique
Complications
•Cholangitis•Biliary stone formation•Anastomotic stricture•Residual debris in the intrahepatic bile
ducts•Intrahepatic bile duct dilatation•Malignancy
Case• An Elsa/ P / 6 th / 10849772 / Bedah I• MRS : 07-07-2008• Dx pre op : Kista Duktus Koledokus ( K82.8 )• Operation : Excisi Kista + Hepatikoyeyunostomi
Roux-en-Y (5-512)• Operator : dr. PW SpBA Ass : dr
WDT SpB/dr ARS SpB
Gallbladder
Choledochal Cyst
Cystic Duct
Gallbladder
Choledochal Cyst
Hepaticojejunostomy Roux-en-Y