1 / 20

CHOLEDOCHAL CYST

CHOLEDOCHAL CYST. OCTOBER 2010. BACKGROUND. • Congenital anomalies of the bile ducts. • First found western literature 1723 (Vater and Ezler). • First systematic description of 96 cases in 1959. • Classification of 5 types (Todani 1977). PATHOPHYSIOLOGY. • Multifunctional

artan
Download Presentation

CHOLEDOCHAL CYST

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CHOLEDOCHAL CYST OCTOBER 2010

  2. BACKGROUND • Congenital anomalies of the bile ducts. • First found western literature 1723 (Vater and Ezler). • First systematic description of 96 cases in 1959. • Classification of 5 types (Todani 1977)

  3. PATHOPHYSIOLOGY •Multifunctional • Majority of choledochal cysts have anomalous junction of common bile duct with pancreatic duct (90%). • This allows reflux of pancreatic secretions and enzymes into common bile duct. • Results in inflammation and weakening of bile duct wall. • Formation of choledochal cyst.

  4. FREQUENCY • Rare in US and western countries. • Reported 1 case per 2 million live births. • Prevalent in Asia 33% cases Japan = 1:1000. • Females 3-4:1

  5. MORTALITY/MORBIDITY • Infants and children – pancreatitis, cholangitis and histological evidence of hepatocellular inflammation and damage. • cholangiocarcinoma 9-28%.

  6. CLASSIFICATION (TODANI 1977) • Type I 80-90% • Type II • Type III • Type IV • Type V

  7. TYPE I CHOLEDOCHAL CYST • Dilation of entire common hapatic and common bile duct or segments of each. • Sacular or fusiform.

  8. TYPE II CHOLEDOCHAL CYST • Relatively isolated protrusion that project from common bile duct wall. • Connected by narrow stalk.

  9. TYPE III CHOLEDOCHAL CYST • Found in intraduodenal portion of the common bile duct (choledochocade).

  10. TYPE IV CHOLEDOCHAL CYST • Multiple dilations of the intrahepatic and extrahepatic biliary tree. • Large extrahepatic cyst with multiple intrahepatic cysts.

  11. TYPE V CHOLEDOCHAL CYSTS • Dilation of intraphepatic biliary radicles. • Numerous cysts with structures causing intraphepatic stone formation, obstruction and cholangitis.

  12. SYMPTOMS • Jaundice • Pale stools (putty colour) • Palpable mass right upper abdominal quadrant • Hepatomegaly • Acute pancreatitis

  13. INVESTIGATIONS • USS abdomen • CT (93%) or MRI (100%) + cholangiogram • HIDA scan • Plain AXR do not identify choledochal cysts well.

  14. TREATMENT TYPE I • Surgery • Complete excision with Rovx-en-y biliary end to side anastromosis to restore biliary continuity to gastrointestinal track.

  15. TREATMENT TYPE II • Total excision

  16. TREATMENT TYPE III • 3 cm or less endoscopic removal. • >3 cm surgical excised.

  17. TREATMENT TYPE IV • Dilated extraphepatic duct removed.

  18. TREATMENT TYPE V • Liver Transplantation

  19. REFERENCES • Btaiche I and Khalidi N (2002). Parenteral Nutrition - Associated Liver Complications in Children. Pharmacotherapy. 22(2): 188- 211 • Howard E, Stringer M and Colombani P (2002) (2ND Ed). Surgery of the Liver, bile ducts and Pancreas in Children. Arnold. London • Piwko J, Caty M, Ryan R (2003). Neonatal considerations for the Paediatric Surgeon. www.emedicine.com/ped/topic2982.htm • Puri P (2003) Newborn Surgery (2nd Ed). Arnold. London • Sadiq J, Nondi B, Lakhoo K (2009). An unusual variant of choledochal cyst : a case report. Journal of Medical Case Reports. 3 : 54

  20. REFERENCES CONT. • Sawyer M, Varma M, Murphy T (2009). Choledochal Cyst. http://emedicine.medscape.com/article/366004-overview • Strodtbeck F(2003) The pathophysiology of prolonged periods of No Enteral Nutrition or Nothing by Mouth. Newborn and Infant Nursing Reviews. www.medscape.com/viewarticle/458473 • Subramanian K, Yoon H and Toral J (2002). Extremely Low Birth Weight Infant. www.emedicine.com/ped/topic2784.htm • Tortora G and Grabowski S (1993) (7TH Ed). Principles of Anatomy andPhysiology. Harper Collins College Publishers. New York Pp790

More Related