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Tuesday, January 22, 2008

Choledochal cysts

Choledochal cysts Liver Disease:

Choledochal cysts are cystic dilatation of the bile duct,Bile Duct After Cyst Excission outside the liver or within which are congenital anomalies of the bile duct. Depending on the morphological appearance they are classified into five different types. This classification was described by Todani in 1977. At the author's center they form the second commonest Hepatobiliary disorder among children requiring surgical correction (News Letter-oct2003). The first case in the literature was reported way back in 1852 by Douglas, in a 17 year old adolescent girl who presented with the classical symptoms of jaundice, pain abdomen and a palpable mass in the abdomen.

Why do they develop?
The causation of the cystic dilatation is probably multifactorial. Majority of patients who present with choledochal cysts, have an anomalous junction of the common bile duct with the pancreatic duct (APBJ); i.e; the pancreatic duct enters the common bile duct one cm proximal to the Ampulla of Vater. This abnormality may result in reflux of the pancreatic secretions into the common bile duct with resultant activation of the pro-enzymes in the alkaline biliary environment and resultant damage of the mucosa of the common bile duct. The other theories include congenital weakness of the wall of the bile duct and defective re-cannalization of the duct during embryonic development of the organs in a foetus.

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