Surgery>>>>>The Gallbladder and Extrahepatic Biliary System
Question 3#

The treatment of choice for a type I choledochal cyst is:

a. Observation
b. Cyst resection and primary re-anastomosis of the common bile duct
c. Resection of the common bile duct, cholecystectomy, and hepatica-jejunostomy
d. Resection of the cyst and choledocho-duodenostomy

Correct Answer is C


Choledochal cysts are rare congenital cystic dilations of the extrahepatic and/or intrahepatic biliary tree. Females are affected three to eight times more commonly than men. Though they are commonly diagnosed in childhood, as many as one half of patients are not diagnosed until adulthood. The most common presentations in adulthood are jaundice and cholangitis, and less than one-half of patients present with the classic clinical triad of abdominal pain, jaundice, and a mass. Ultrasonography (US) or computed tomographic (CT) scanning will confirm the diagnosis, but a more definitive imaging technique such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography, or magnetic resonance cholangiopancreatography (MRCP) is required to assess the biliary anatomy and plan the appropriate surgical treatment. The risk of cancer development in these patients is up to 1 5%, and can largely be mitigated by excision of the biliary tree. Types I, II, and IV cysts are treated with excision of the extrahepatic biliary tree with a Roux-en-Y hepaticojejunostomy. Type IV may also require a segmental liver resection. Sphincterotomy is recommended for type III cysts.