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Management dilemmas with choledochal cysts.

Matthew S Metcalfe1, Simon A Wemyss-Holden, Guy J Maddern

  • 1Department of Surgery, the Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.

Archives of Surgery (Chicago, Ill. : 1960)
|March 4, 2003
PubMed
Summary

Choledochal cysts, rare bile duct anomalies, are often incidentally found. Complete surgical excision with hepaticojejenostomy is the recommended treatment for these congenital abnormalities.

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Area of Science:

  • Gastroenterology
  • Pediatric Surgery
  • Hepatobiliary Surgery

Background:

  • Choledochal cysts are rare congenital biliary tract malformations with unclear etiology.
  • Clinical presentation is variable, with the classic triad of pain, jaundice, and abdominal mass infrequently observed.
  • Potential complications include pancreatitis, cholangitis, and a significantly increased risk of cholangiocarcinoma.

Purpose of the Study:

  • To review current knowledge and evidence regarding choledochal cysts.
  • To establish evidence-based management recommendations for choledochal cysts.

Main Methods:

  • Comprehensive literature review of English-language articles indexed on MEDLINE.
  • Analysis of classification, presentation, diagnosis, etiology, malignant transformation, and management strategies.

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Main Results:

  • Established classification systems for choledochal cysts.
  • Detailed the diverse clinical presentations and optimal diagnostic approaches.
  • Summarized etiological theories and factors associated with malignant transformation.
  • Evaluated outcomes of various surgical and non-surgical management options.

Conclusions:

  • Choledochal cysts are frequently diagnosed during investigations for non-specific symptoms or incidentally.
  • Magnetic resonance imaging (MRI) is the preferred modality for diagnosing and characterizing choledochal cysts.
  • Surgical management of choice involves complete cyst excision followed by hepaticojejunostomy.