Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

304 Choledochal Cysts

General Measures

■history, physical, LFTs and imaging studies to determine liver dam-

age and assess surgical candidacy

specific therapy

Indications

■initial management depends on the age, presentation and type of

the cyst

■ERCP plays a major role in the diagnosis and classification of biliary

cystic disease and, in fewer instances, in its therapy (type III)

■cholecystectomy must be performed with cyst resection in all

patients to reduce the risk of cancer, with type III cysts as the only

possible exception

■acute suppurative cholangitis: broad-spectrum, intravenous antibi-

otics and endoscopic/percutaneous biliary decompression

■severe biliary pancreatitis: ERCP followed by resection of the cyst

■type III cysts varies with the presentation:

➣endoscopic sphincterotomy for biliary and pancreatic symptoms

➣resection for duodenal obstruction (malignancy rare with type

III cysts)

Therapeutic Options

■Type/Procedure of choice

■gallbladder cysts/cholecystectomy

■cystic duct cysts/cholecystectomy

■choledochal cyst type I/Roux-en-Y hepaticojejunostomy

■choledochal cyst type II/excision of diverticulum

■choledochal cyst type III/endoscopic sphincterotomy

■choledochal cyst type IV/Roux-en-Y hepaticojejunostomy

■choledochal cyst type V/hepatic resection/ liver transplantation

follow-up

■postoperative surveillance: incomplete resection

complications and prognosis

■complications of choledochal cyst disease:

➣gallstones

➣acute cholecystitis

➣pancreatitis

➣recurrent cholangitis

➣liver abscesses