Yonsei Med J.  2006 Dec;47(6):826-832. 10.3349/ymj.2006.47.6.826.

Management Strategy for Congenital Choledochal Cyst with Co-existing Intrahepatic Dilation and Aberrant Bile Duct As Well As Other Complicated Biliary Anomalies

• Dong Q
• Jiang B
• Zhang H
• Jiang Z
• Lu H
• Yang C
• Cheng Y
• Hao X

• KMID: 1777172
• DOI: http://doi.org/10.3349/ymj.2006.47.6.826

Abstract

The purpose of this study was to investigate and discuss imaging methods and management strategies for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies. In this study we reviewed and analyzed 72 patients with congenital choledochal cyst, ranging in age from 15 days to 12 years old and who were seen at our hospital during the past 12 years, from January 1993 to October 2005. The image manifestation and clinical significance of patients with co- xisting intrahepatic biliary dilation and aberrant bile duct were carefully examined during operation via MRCP, cholangiography and choledochoscope. Twenty-two cases (30.1%) presented with intrahepatic bile duct dilation and 12 of these were of the cystic type. That is, the orifice of the dilated intrahepatic tract that converged into the common hepatic duct showed membrane or septum-like stenosis. In 10 cases the dilation tapered off from the porta hepatis to the initiating terminals of the intra-hepatic bile ducts and was not accompanied by stenosis. An aberrant bile duct was observed in 2 of the cases. In 3 cases, the right and left hepatic ducts converged at the choledochal cyst. In conclusion, the imaging methods for intrahepatic bile duct dilation possess important clinical significance. Further, for hepatojejunostomy with radical excision of a choledochal cyst, additional operative procedures for intrahepatic stenosis, possible bile duct malformation and pancreaticobiliary common duct calculi can potentially reduce postoperative complications.

Keyword

Congenital choledochal cyst; surgical treatment; intrahepatic bile duct dilatation; intrahepatic bile duct stenosis; aberrant bile duct

MeSH Terms

Tomography, X-Ray Computed
Postoperative Complications/ultrasonography
Male
Liver Diseases/complications/*radiography/surgery
Infant, Newborn
Infant
Humans
Female
Choledochal Cyst/complications/*radiography/surgery
Cholangiography
Child, Preschool
Child
Bile Ducts/*abnormalities/pathology/surgery

Figure

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  Fig. 1 (A) CT image of congenital choledochal cyst accompanied by intrahepatic bile duct dilation. (B) CT image of a huge choledochal cyst with obvious intrahepatic bile duct dilation.

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  Fig. 2 3-D CT image showing intrahepatic bile duct dilation.

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  Fig. 3 MRI showing intrahepatic bile duct dilation and a long common pancreatico-biliary channel.

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  Fig. 4 (A). MRCP showing an aberrant bile duct directly accessed from the liver into the cystic duct near the choledochus. (B). After choledochus and cyst excision, anastomosis between the aberrant bile duct and common hepatic duct was performed before Roux-en-Y hepatojejunostomy. MRCP showed that the anastomosis between the aberrant bile duct and common hepatic duct was seamless and bile drainage was unimpeded.

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  Fig. 5 Operative cholangiography showed an aberrant bile duct with direct access into the dilated choledochus cyst from the liver.

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