Choledocal Cysts, Their Symptoms and Surgical Treatment

by Rahul Singh Content Writer

Introduction

Choledocal cysts, also known as bile duct cysts are a congenital condition,related to gastroenterology, involving the dilatation of the bile ducts due to cyst formation. Choledocal cysts occur in both infants and adults, although it is rare for its symptoms to remain undetected until adulthood. If and when diagnosed in adulthood, patients usually have other complications associated with Choledocal cysts. There are 7 types of Choledocal cysts, namely:

Type I, the most common.
Type II
Type III, or Choledochocele
Type IV(a)
Type IV(b)
Type V
Type VI

Symptoms

Symptoms of Choledocal cysts, in both infants and in adults are listed below:

Symptoms in infants include:

o Jaundice

o Acholic stools (pale or clay coloured stools lacking bile)

o Enlarged liver, with a visible mass in upper right abdomen.

o Abdominal pain

o Pancreatitis

Symptoms in adults include:

o Abdominal pain, which is the most common symptom

o Pain in the upper right quadrant of the abdomen

o Jaundice

o Cholangitis

o One or more complications like hepatic abscesses, cirrhosis, portal hypertension and recurrent pancreatitis.

Surgical Treatment

No medical therapy specifically targets Choledocal cysts, nor is any drug or any type of non-surgical treatment helpful. Surgery is thus, the only option of treatment, and even that may not be viable for individuals who have late stage Choledocal cysts, due to the prohibitive morbidity and mortality associated with the late stages of the condition. The surgical treatment for each type of Choledocal cyst includes:

· Type I: The affected portion of the bile duct is removed via the surgery and a Roux-en-Y hepaticojejunostomy is performed to restore biliary-enteric function.

· Type II: The dilated diverticulum due to cysts is removed, and the resultant defect in the bile duct is closed.

· Type III: Choledochoceles (cysts) measuring 3 cm or less can be treated effectively with endoscopic sphincterotomy, whereas those larger than 3 cm (which typically produce obstruction) are removed surgically.

· Type IV: Complete removal of the dilated extrahepatic duct if the liver is required, and is followed by a Roux-en-Y hepaticojejunostomy to restore continuity.

· Type V: Hepatic lobectomy (removal of a lobe of the liver) is required if the disease is limited to one hepatic lobe (left lobe is usually affected). But if the disease is bilobar (involving two lobes), it might require liver transplantation.

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