Choledochal cysts, also known as congenital bile duct dilatation, refer to abnormal swellings or cysts in the bile duct. The bile duct is a tube that carries bile from the liver and gallbladder to the small intestine. Cysts arise due to abnormal dilation or swelling of some part of the bile duct.
Causes of Choledochal Cysts
The exact cause of choledochal cysts is unknown. Some theories suggest it may be due to abnormalities in the bile duct during fetal development or genetic factors that can make a person prone to bile duct abnormalities.
Types of Choledochal Cysts
There are different types of choledochal cysts classified based on their location and appearance:
– Type I – Dilatation of the common bile duct
– Type II – Diverticular protrusion from the common bile duct
– Type III – Segmental dilatation involving the common bile duct
– Type IV – Multiple dilatations involving the intra and extrahepatic bile ducts
– Type V – Solitary cystic dilatation of bile ducts within the liver
Diagnosis of Choledochal Cysts
Diagnosis involves a combination of medical history, clinical examination and imaging tests like abdominal ultrasound, CT scan or MRI of abdomen and ERCP.
For smaller cysts confined to the common bile duct, cyst excision surgery is done to remove the cyst.
Massive Choledochal Cysts
In massive cysts involving extrahepatic bile ducts, the treatment is removal of the cysts and connecting the bile ducts directly to the small intestine in a procedure called hepaticojejunostomy.
Complicated Choledochal Cysts
Extensive cysts stretching into the liver may require complex surgery or even liver transplantation to remove the cyst completely and prevent complications.
Choledochal Cyst Surgery
The main goal of surgery is complete excision of the cyst to remove the risk of complications like liver damage, bile duct stones, bile duct cancer or pancreatitis.
Symptoms of Choledochal Cysts
Common symptoms include abdominal pain, jaundice, fever, nausea or vomiting and fatigue.
Complications of Choledochal Cysts
Untreated cysts can lead to cirrhosis, bile duct stones, bile duct cancer or pancreatitis.
Q1. Can choledochal cysts recur after surgery?
A1. Recurrence is rare if the entire cyst is excised completely. Lifelong follow up is needed.
Q2. What is the long term outlook after surgery?
A2. Prognosis is generally good if cyst is treated surgically before complications. Regular checkups are important.
Q3. At what age can choledochal cysts be detected?
Dr. DasGupta says choledochal cysts have no strict age limit for detection. Rarely, prenatal scans may identify them in-utero. Newborns may present with jaundice. Most common age is 2-5 years when symptoms emerge. However, asymptomatic cysts can also be incidentally detected in older children/adults during tests. Regardless of age, anyone experiencing abdominal pain, fever or vomiting should consult a doctor for evaluation and timely treatment if needed.
Q4. How is surgery for choledochal cysts performed?
Dr. DasGupta states that the surgical method depends on the type, size and extent of the cyst. For smaller Type I cysts, a simple excision may suffice. Whereas massive extrahepatic cysts often require hepapticojejunostomy to reconnect bile flow. Complicated intrahepatic cysts may need partial liver resection or rarely, transplantation under expert surgical guidance. Complete cyst removal with minimal bile duct injury is the goal.
Q5. What is the role of lifelong follow up post-surgery?
Follow up plays a key role according to Dr. DasGupta. Though chances of recurrence after proper excision are low, screening for new cyst formations or complications is important even decades later. Regular checks through imaging and blood tests can detect issues early and prevent problems like gallstones, cirrhosis or cancer in the long run.
In conclusion, choledochal cysts require complete surgical excision to prevent long term issues, according to Dr. Sayandev DasGupta. With over 20 years of experience in GI and biliary surgeries, he emphasizes the importance of timely diagnosis and treatment for optimal outcomes. Dr. DasGupta is one of Kolkata’s leading General & Laparoscopic Surgeons, renowned for his expertise in choledochal cyst management and minimally invasive procedures. If you need specialist care for choledochal cysts or other digestive conditions, contact Dr. DasGupta’s office today to schedule a consultation. You can reach them at +91-9830030390 or visit https://www.drsayandasgupta.com/ for more details. His multidisciplinary team is dedicated to providing world-class surgical care and management for all patients.