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. 1981 May;193(5):666–676. doi: 10.1097/00000658-198105000-00018

Management of adult choledochal cysts.

C S Powell, J L Sawyers, V H Reynolds
PMCID: PMC1345144  PMID: 7235770

Abstract

A review of the English literature reveals a total of 1,337 patients with choledochal cysts. Improved diagnostic techniques to visualize the biliary system are demonstrating an increasing number of unsuspected choledochal cysts in adult patients. Either choledochal cysts remain clinically silent until adulthood or may develop in later life. Experience is reported with adult patients having type I, II, III, and IV choledochal cysts. Type I cysts are preferably managed by excision but cyst anatomy may necessitate choledochoenteric drainage. Type II cysts are treated by excision except for those located within the pancreatic portion of the common bile duct. These are best managed by transduodenal cystoduodenostomy. The type III cyst (choledochocele) should be excised carefully, identifying and preserving the common bile and pancreatic ducts. Type IV cysts include a combination of any one of the first three types of cyst plus the presence of intrahepatic cyst or cysts. Treatment of these cysts is dictated by the type and location of the extrahepatic cyst. Since choledochal cysts are being recognized with increased frequency in adults, surgeons need to be aware of the diagnostic and treatment modalities available for each type of biliary cyst.

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Selected References

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  1. ATTAR S., OBEID S. Congenital cyst of the common bile duct; a review of the literature and a report of two cases. Ann Surg. 1955 Aug;142(2):289–295. doi: 10.1097/00000658-195508000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Babbitt D. P., Starshak R. J., Clemett A. R. Choledochal cyst: a concept of etiology. Am J Roentgenol Radium Ther Nucl Med. 1973 Sep;119(1):57–62. doi: 10.2214/ajr.119.1.57. [DOI] [PubMed] [Google Scholar]
  3. Brooks B., Weinstein A. CYST OF THE AMPULLA OF VATER: CASE REPORT. Ann Surg. 1943 May;117(5):728–734. doi: 10.1097/00000658-194305000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. FURTH J., GADSEN E. L., UPTON A. C. Hyperplasia and cystic dilatation of extrahepatic biliary tracts in mice bearing grafted pituitary growths. Cancer Res. 1952 Oct;12(10):739–743. [PubMed] [Google Scholar]
  5. Flanigan P. D. Biliary cysts. Ann Surg. 1975 Nov;182(5):635–643. doi: 10.1097/00000658-197511000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fonkalsrud E. W. Surgical pros and cons. Surg Gynecol Obstet. 1978 Dec;147(6):917–919. [PubMed] [Google Scholar]
  7. Glass T. A., Buschi A. J., Brenbridge A. N., Shaffer H. Choledochal cyst: sonographic evaluation of an unusual case. South Med J. 1980 Oct;73(10):1391–1393. [PubMed] [Google Scholar]
  8. Klotz D., Cohn B. D., Kottmeier P. K. Choledochal cysts: diagnostic and therapeutic problems. J Pediatr Surg. 1973 Apr;8(2):271–283. doi: 10.1016/s0022-3468(73)80095-8. [DOI] [PubMed] [Google Scholar]
  9. Lilly J. R. The surgical treatment of choledochal cyst. Surg Gynecol Obstet. 1979 Jul;149(1):36–42. [PubMed] [Google Scholar]
  10. Lilly J. R. Total excision of choledochal cyst. Surg Gynecol Obstet. 1978 Feb;146(2):254–256. [PubMed] [Google Scholar]
  11. Longmire W. P., Jr, Mandiola S. A., Gordon H. E. Congenital cystic disease of the liver and biliary system. Ann Surg. 1971 Oct;174(4):711–726. doi: 10.1097/00000658-197110000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. McClelland R. N. Controversy about the surgical treatment of choledochal cysts. Gastroenterology. 1978 Jun;74(6):1336–1337. [PubMed] [Google Scholar]
  13. Morgan C. L., Trought W. S., Oddson T. A., Thompson W. M. Ultrasonography in the diagnosis of a type 1 choledochal cyst. South Med J. 1980 Oct;73(10):1389–1391. doi: 10.1097/00007611-198010000-00030. [DOI] [PubMed] [Google Scholar]
  14. O'Neill J. A., Jr, Clatworthy H. W., Jr Management of choledochal cysts: a fourteen-year follow-up. Am Surg. 1971 Apr;37(4):230–237. [PubMed] [Google Scholar]
  15. Rosenthall L., Shaffer E. A., Lisbona R., Pare P. Diagnosis of hepatobiliary disease by 99mTc-HIDA cholescintigraphy. Radiology. 1978 Feb;126(2):467–474. doi: 10.1148/126.2.467. [DOI] [PubMed] [Google Scholar]
  16. Saito S., Ishida M. Congenital choledochal cyst (cystic dilatation of the common bile duct). Prog Pediatr Surg. 1974;6:63–90. [PubMed] [Google Scholar]
  17. Shallow T. A., Eger S. A., Wagner F. B. CONGENITAL CYSTIC DILATATION OF THE COMMON BILE DUCT : CASE REPORT AND REVIEW OF LITERATURE. Ann Surg. 1943 Mar;117(3):355–386. doi: 10.1097/00000658-194303000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Spitz L. Choledochal cyst. Surg Gynecol Obstet. 1978 Sep;147(3):444–452. [PubMed] [Google Scholar]
  19. TSARDAKAS E., ROBNETT A. H. Congenital cystic dilatation of the common bile duct; report of three cases, analysis of fifty-seven cases, and review of the literature. AMA Arch Surg. 1956 Feb;72(2):311–327. doi: 10.1001/archsurg.1956.01270200127024. [DOI] [PubMed] [Google Scholar]
  20. Todani T., Tabuchi K., Watanabe Y., Kobayashi T. Carcinoma arising in the wall of congenital bile duct cysts. Cancer. 1979 Sep;44(3):1134–1141. doi: 10.1002/1097-0142(197909)44:3<1134::aid-cncr2820440350>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  21. Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg. 1980 Nov;140(5):653–657. doi: 10.1016/0002-9610(80)90051-3. [DOI] [PubMed] [Google Scholar]

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