Adult choledochal cysts: current update on classification, pathogenesis, and cross-sectional imaging findings

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Pediatric Surgery
• Medical Imaging

Background:

• Choledochal cysts (CCs) are congenital biliary dilatations, with approximately 20% presenting in adulthood.
• Adult-onset CCs and late complications in treated children, including malignancy, highlight the need for ongoing surveillance.
• Understanding the evolving classification and pathogenesis of CCs is crucial for effective management.

Purpose of the Study:

• To review the current understanding of choledochal cyst classification, pathogenesis, and the role of imaging.
• To discuss the implications of CCs in both adult and pediatric populations.
• To highlight the importance of diagnostic and surveillance imaging in managing CCs.

Main Methods:

• Review of current literature on choledochal cyst classification and etiology.
• Discussion of diagnostic and surgical management strategies.
• Emphasis on the role of imaging modalities in diagnosis and follow-up.

Main Results:

• CCs present unique challenges in adults and can lead to late complications in previously treated children.
• The Todani classification system is widely used but evolving, with proposals for simplified schemes.
• Key etiological theories include anomalous pancreatico-biliary junction and antenatal biliary obstruction.

Conclusions:

• Accurate classification and understanding of pathogenesis are vital for managing choledochal cysts.
• Imaging plays a critical role throughout the patient journey, from initial diagnosis to long-term surveillance.
• Continued research is needed to fully elucidate the etiology and optimize treatment strategies for CCs.