Choledochal cyst

Abstract

Radical excision of the choledochal cyst and reconstruction by hilar hepaticojejunostomy are the optimal treatments for the choledochal cyst. This disconnects the pancreatic and biliary ducts. Internal drainage of the cyst by cystenterostomy has a prohibitively high long-term morbidity from cholangitis, stone formation, and malignant change and should be avoided. Definitive surgical excision may be unsafe in a critically sick children with perforation or serious concomitant complications. In such cases, temporary external drainage such as cholecystostomy, and delayed surgery once the patient has improved and the anatomy has been defined, is safer. Postoperative complications are relatively rare, but early problems may include an anastomotic bile leakage, bleeding, intra-abdominal sepsis, injury to adjacent structures, and wound complications. Late complications are anastomotic stricture of the hepatico- jejunostomy, hepatolithiasis, pancreatitis from residual abnormalities in the common channel, and adhesive ileus. Even after adequate cyst excision, malignancy may very rarely affect residual extrahepatic ducts.