What is Choledochal Cyst ?

November 7, 2023 By Dr. Ashish Prasad

What is Choledochal Cyst ?

Choledochal cyst is a birth defect, characterized by the swelling or cystic transformation of the bile duct. The liver produces bile to digest food. Bile duct helps in transporting bile from the liver to the gall bladder and small intestines.

In case of a choledochal cyst, due to the obstruction of drainage, passage of the bile is hampered, thereby causing pain, indigestion, jaundice. Child can have repeated episodes of infection in bile duct characterised by fever, pain and jaundice. Early treatment of this condition, may reduce the risk of liver cirrhosis and bile duct cancer in adulthood.

Choledochal cyst is a rare condition, as its presence is seen in only 1 out of 1,00,000-1,50,000 children in the western countries. Girls are 4 times more prone to it than boys. Experts are of the view, that choledochal cysts occur when the junction between the bile duct and pancreatic duct is not normal. Bile duct carries bile from the liver,  to the duodenum which is the first part of the small intestine. Before joining duodenum it joins  pancreatic duct. In case of an abnormality, pancreatic juice may flow backwards, into the bile duct, thereby causing the formation of cysts. Also obstruction at lower end of bile duct can cause this problem.

Even though Choledochal cyst is a birth defect and the condition may be diagnosed on antenatal scan, it's symptoms may appear in infancy or in older children. The common symptoms include -:

  • Pain sensation in upper right portion of the stomach or belly
  • Abdominal mass
  • Fever
  • Jaundice
  • Nausea and Vomiting

Choledochal cysts can be intrahepatic, where it occurs in the bile duct inside the liver, or can be extrahepatic (outside the liver).

Following are the 4 different types of Choledochal cysts that are identified by their location

  • Type 1 Choledochal Cyst - This accounts for upto 90% of all choledochal cysts. It is the cyst of the extrahepatic bile duct.
  • Type 2 Choledochal Cyst - This occurs as an abnormal pouch or a sac opening from the duct
  • Type 3 Choledochal Cyst - This cyst is found inside the wall of the duodenum
  • Type 4 Choledochal Cyst - These are cysts that are present on both intrahepatic and extrahepatic bile ducts.

Ultrasound and MRI are required to confirm the diagnosis.

The treatment of choledochal cyst is surgical. It requires excision of cyst and joining the small intestine (duodenum or jejunum) with remaining bile duct.

Treatment of Choledochal Cysts with Minimally Invasive Surgery

Minimally Invasive Surgery is done through a small incision, using miniaturized surgical tools and cameras or telescopes.

Laparoscopic Surgery is a popular form of Minimally Invasive Surgery (MIS) for the removal of Choledochal Cyst. In this, the surgeon uses small instruments, which are guided by a small telescope.

The surgery is performed by the surgeon who manipulates the instruments while watching them on a video screen.