What is Choledochal Cyst ?
Choledochal cyst is a birth defect, characterized by the swelling or cystic transformation of the bile duct.
The liver produces bile to digest food. Bile duct helps in transporting bile from the liver to the gall bladder and small intestines.
In case of a choledochal cyst, due to the obstruction of drainage, passage of the bile is hampered, thereby causing pain, indigestion, jaundice. Child can repeated episodes of infection in bile duct characterised by fever, pain and jaundice. Early treatment of this condition, may reduce the risk of liver cirrhosis and bile duct cancer in adulthood.
Choledochal cyst is a rare condition, as it’s presence is seen in only 1 out of 1,00,000-1,50,000 children in the western countries. Girls are 4 times more prone to it than boys.
Symptoms of Choledochal Cyst:
Even though Choledochal cyst is a birth defect, it’s symptoms may appear in infancy or in older children. Condition may be diagnosed on antenatal scan.
Pain sensation in upper right portion of the stomach or belly
Abdominal mass
Fever
Jaundice
Nausea and Vomiting
Causes of Choledochal Cyst:
Experts are of the view, that choledochal cysts occur when the junction between the bile duct and pancreatic duct is not normal.
Bile duct carries bile from the liver, to the duodenum which is the first part of the small intestine. Before joining duodenum it joins pancreatic duct. In case of an abnormality, pancreatic juice may flow backwards, into the bile duct, thereby causing the formation of cysts. Also obstruction at lower end of bile duct can cause this problem.
The different types of Choledochal Cyst and their locations:
Choledochal cysts can be intrahepatic, where it occurs in the bile duct inside the liver, or can be extrahepatic (outside the liver).
Following are the 4 different types of Choledochal cysts that are identified by their location
Type 1 Choledocal Cyst – This accounts for upto 90% of all choledochal cysts. It is the cyst of the extrahepatic bile duct.
Type 2 Choledochal Cyst – This occurs as an abnormal pouch or a sac opening from the duct
Type 3 Choledocal Cyst – This cyst is found inside the wall of the duodenum
Type 4 Choledocal Cyst – These are cysts that are present on both intrahepatic and extrahepatic bile ducts.
Ultrasound and MRI are required to confirm the diagnosis.
Treatment of Choledochal Cysts with Minimally Invasive Surgery.
The treatment of choledochal cyst is surgical. It requires excision of cyst and joining the small intestine (duodenum or jejunum) with remaining bile duct.
"Less pain, less scarring and faster recovery are some of the benefits of a Minimally Invasive Surgery (MIS)" – Says Dr. Prashant Jain, the best paediatric surgeon in India.
Minimally Invasive Surgery is done through a small incision, using miniaturized surgical tools and cameras or telescopes.
Laparoscopic Surgery is a popular form of Minimally Invasive Surgery (MIS) for the removal of Choledochal Cyst. In this, the surgeon uses small instruments, which are guided by a small telescope.
The surgery is performed by the surgeon who manipulates the instruments while watching them on a video screen.
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Dr. Prashant Jain is one of the Best Pediatric Urologist, Best Pediatric Surgeon and Pediatric Laparoscopic Surgeon In Delhi, India. He has been a meritorious student throughout his medical career and was gold medalist in his training in pediatric surgery and pediatric urology.