True about choledochal cyst -
Ans. is 'd' i.e., Rupture may lead to biliary peritonitis Choledochal cyst* A choledochal cyst is an isolated or combined congenital dilatation of the extrahepatic or intrahepatic biliary tree.Classification of Choledochal cystType I- a type I cyst is characterized by fusiform dilatation of the bile duct.- this is the most common typeType II- a type II cyst appears as a diverticulum protruding from the wall of the CBD.Type III- a type III cyst is dilatation of the biliary tract within the duodenum; also k/a choledochoceleType IV Type IV A- multiple dilatation of the intrahepatic and extrahepatic bile ducts.Type IV B- multiple dilatation involving only the extrahepatic bile ducts.Type V- consists of multiple dilatation of the intrahepatic bile ducts; also known as Carolis disease.* Choledochal cysts are seen to be frequently associated with an anomalous junction of the pancreatic and biliary duct.Clinical Presentation* More common in females than in males (4:1)* Typically choledochal cysts present in children beyond the toddler age group.* The classical triad presents only in a minority of patients; it consists of:# Abdominal pain# Jaundice# Abdominal mass* If the disorder is left undiagnosed, patients may develop cholangitis or pancreatitis. Cholangitis may lead to the development of cirrhosis and portal hypertension.Complications caused by choledochal cyst* Recurrent cholangitis* Portal vein thrombosis with resultant portal hypertension* Pancreatitis* Cyst rupture with biliary peritonitis (very rarely)* Gall stones* Malignancy* Cirrhosis with portal hypertension Diagnosis* ERCP is the most reliable investigation but is invasive* MRCP is the best noninvasive investigationTreatment* Cholecystectomy + Cyst excision with reconstruction via a biliary-enteric Roux-en-Y anastomosis is the treatment of choice for all choledochal cysts except type III (choledochocele) and intrahepatic cysts of type IV & type V (Carolis disease)* Treatment of type III (Choledochocele)# Transduodenal sphincteroplasty or sphincterotomy# cyst excision* Treatment of intrahepatic cysts of type IV & V# If the intrahepatic cysts are localized, hepatic lobe is resected# If the intrahepatic cysts are diffuse only effective treatment is liver transplantation.
Type II is most common
Cyst excision is the treatment of choice
Anamolous connection between biliary and pancreatic duct
Rupture may lead to biliary peritonitis
Gall Bladder & Bile Ducts