Scientific paperSome considerations for management of choledochal cysts†☆
Section snippets
Patients
Our management of 16 patients with choledochal cysts was based primarily on a review of the literature. Nine had type I (diffuse dilation of the extrahepatic bile ducts), 1 had type II (saccular diverticulum of the common duct), 1 had type III (choledochocele within the wall of the duodenum (Fig. 2), 3 had type IV-A (similar to type I, but in addition intrahepatic ducts are involved), 1 had type IV-B (multiple dilatations of the extrahepatic ducts and normal intrahepatic ducts), and 1 had type
Results
Diagnosis of choledochal cysts was most simply achieved by US examination; ERCP and percutaneous transhepatic cholangiography were more definitive in displaying ductal anatomy and the existence of an anomalous pancreatic bile duct junction. An anomalous pancreaticobiliary duct junction with a long common channel was identified in 56% (9 of 16) of our patients and 53% of those of Chaney et al [10]. The ductal junction was normal in 2 patients. Demonstration of the pancreaticobiliary junction was
Comments
Most observers agree that choledochal cysts are associated with an abnormal communication between the common bile duct and the pancreatic duct that allows reflux of pancreatic juice into the bile duct [9]. Injury of the bile ducts by activated pancreatic juice is presumed to cause their dilatation. We documented an abnormal junction in 9 patients. All patients with anomalous pancreaticobiliary duct junction do not have a choledochal cyst [13], but 93% of choledochal cysts are associated with an
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†This study originally appeared in the March issue (Am J Surg 2004;187:434–439) and has been reprinted with corrections.