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| MEDICAL IMAGES |
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| Year : 2013 | Volume
: 4
| Issue : 2 | Page : 133 |
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Cystic dilatation of common bile duct in an adult
Prathvi Shetty, Leo Francis Tauro, Ashwin Alva
Department of Surgery, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| Date of Web Publication | 16-Sep-2013 |
Correspondence Address:
Prathvi Shetty
Department of Surgery, Father Muller Medical College and Hospital, Kankanady, Mangalore - 575 002, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-9727.118249
How to cite this article:
Shetty P, Tauro LF, Alva A. Cystic dilatation of common bile duct in an adult. Muller J Med Sci Res 2013;4:133 |
A 42-year-old lady presented with complains of abdominal bloating and right hypochondrial pain for past one week. Physical examination showed tenderness in the right hypochondrium. Blood investigations including total count, liver function test, and renal parameters were within normal. Ultrasonography revealed multiple calculi in the common bile duct. She underwent endoscopic retrograde cholangiopancreaticography, which revealed fusiform dilatation of the common bile duct with multiple calculi which were evacuated [Figure 1]. The diagnosis of choledochal cyst was made.
Choledochal cysts are congenital cystic anomaly of the biliary tree, either extra hepatic, intrahepatic or both. Todani classified it into five types with type one being the fusiform or saccular dilatation of the common bile duct (CBD), which is the most common type among others (80%). These are usually seen in children and rarely seen in adults with predilection more towards females than males (4:1). [1] They are commonly seen in the east asian population likeJapan and China than in western regions. Etiopathogenesis is unsure with multifactorial cause hypothesis being put forward. The classical presentation of abdominal pain, jaundice, and right hypochondrial palpable mass is seen in 10-20% but common presentation is of abdominal pain in adults. They also do present with jaundice and cholangitis. [2] Endoscopic retrograde cholangiopancreaticography (ERCP), computerized tomography scan, and magnetic retrograde cholangiopancreaticography are required after the preliminary investigation for the precise anatomical detail of the biliary cyst. [3],[4] The risk of malignant change in choledochal cysts leading to cholangiocarcinama is increased in adults with other complications being cholelithiasis, recurrent pancreatitis, hepatic abscess, cirrhosis, and portal hypertension. The ideal treatment is excision of the entire dilated biliary tree with reconstruction using a Roux-en-Y hepaticojejunostomy. [5]
| References | |  |
| 1. | Khandelwal C, Anand U, Kumar B, Privadarshi RN. Diagnosis and management of choledochal cysts. Indian J Surg 2012;74:29-34. 
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| 2. | Gong L, Qu Q, Xiang X, Wang J. Clinical analysis of 221 cases of adult choledochal cysts. Am Surg 2012;78:414-8.
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| 3. | Liu YB, Wang JW, Devkota KR, Ji ZL, Wang XA, Ma XM, et al. Congenital choledochal cysts in adults: Twenty-five-year experience. Chin Med J (Engl) 2007;120:1404-7.
[PUBMED] |
| 4. | Liu QY, Lai DM, Gao M, Wan YL, Lin XF, Liang BL. MRI manifestations of adult choledochal cysts associated with biliary malignancy: A report of ten cases. Abdom Imaging 2012;22.
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| 5. | You Y, Gong JP. Diagnosis and management experience of adult choledochal cysts: Reasons for reoperation. Hepatogastroenterology 2013;3:60.
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[Figure 1]
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