Diagnosis and management of choledochal cyst: 20 years of single center experience

Abstract

We report the first case series from Africa and the Middle East on choledochal cyst, a disease which shows significant geographical distribution with high incidence in the Asian population. In this study, the epidemiological data of the patients are presented and analyzed. Attention was paid to diagnostic imaging and its accuracy in the diagnosis and classification of choledochal cyst. Most cases of choledochal cyst disease have type I and IV-A cysts according to the Todani classification system, which support the etiological theories of choledochal cyst, especially Babbitt's theory of the anomalous pancreaticobiliary duct junction, which are clearly stated. The difficulties and hazards of surgical management and methods used to avoid operative complications are clarified. Early and late postoperative complications are also included. This study should be followed by multicenter studies throughout Egypt to help assess the incidence of choledochal cysts in one of the largest populations in Africa and the Middle East.

Keywords: Caroli disease; Choledochal cyst; Hepatectomy; Hepatic cyst; Hepaticojejunostomy.

Figure 1

Ultrasound imaging and abdominal computed tomography of type I choledochal cyst. A: Ultrasound imaging; B: Abdominal CT. CC: Choledochal cyst; GB: Gall bladder; CBD: Common bile duct; CT: Computed tomography.

Figure 2

Magnetic resonance cholangiopancreatography images of choledochal cyst. A: Type IV-A choledochal cyst with anomalous pancreaticobiliary duct junction (white arrow); B: Type I choledochal cyst with multiple stones inside (white arrow). IHB: Intrahepatic biliary radicals; CHD: Common hepatic duct; GB: Gall bladder; CBD: Common bile duct.

Figure 3

Anomalous pancreaticobiliary duct junction detected by cholangiography (white arrow). A: Percutaneous transhepatic cholangiography of type IV-A choledochal cyst; B: MRCP of type IV-A choledochal cyst. MRCP: Magnetic resonance cholangiopancreatography.

Figure 4

Surgical excision of choledochal cyst. A: Exposure of type IA choledochal cyst; B: Division of biliary system at the carina proximal to the cyst; C: The biliary system after excision of the cyst; D, E: Restoration of biliary continuity by hepaticojejunostomy; F: The specimen after complete excision of the cyst consisting of gall bladder (GB) and choledochal cyst (CC).