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Pediatric choledochal cysts: diagnosis and current management
Kevin C Soares1, Seth D Goldstein2, Mounes A Ghaseb3
1Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Pediatric Surgery International
|April 2, 2017
Summary
Choledochal cysts are rare congenital biliary tract disorders. Management involves surgical excision, with generally excellent outcomes but a persistent risk of malignancy.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Medical Imaging
Background:
- Choledochal cysts (CC) are rare congenital anomalies.
- Anomalous pancreaticobiliary union (APBDU) is a suspected contributing factor.
- CCs are associated with inflammation, hepatitis, cholangitis, and pancreatitis.
Purpose of the Study:
- To review the etiology, classification, diagnosis, and management of choledochal cysts.
- To highlight the association between CC and malignancy.
- To discuss current diagnostic and therapeutic approaches.
Main Methods:
- Review of existing literature on choledochal cysts.
- Discussion of diagnostic modalities including CT, MRI, ultrasound, and MRCP.
- Emphasis on surgical management including cyst excision and reconstruction.
Main Results:
- Todani classification (1977) categorizes CC into five types; Types I and IV are most common and linked to malignancy.
- Diagnosis often occurs in childhood, presenting with nonspecific abdominal pain.
- MRCP has largely replaced PTC and ERCP for diagnosis.
Conclusions:
- Prompt surgical excision is the standard management for choledochal cysts.
- Minimally invasive techniques show promise in pediatric cases.
- While prognosis is good, malignancy risk persists post-excision.