Choledochal Cyst in Children: Risks and Treatment Options of Bile Duct Obstruction

Choledochal cyst in children may increase the risk of bile duct obstruction and bile duct infection!Minimally invasive surgery has many benefits

A newborn was found to have a common bile duct cyst through ultrasound examination before birth, so he was transferred to the hospital for further examination. The diagnosis was diagnosed as type IV biliary cyst through ultrasound and computed tomography scan. Because the patient currently has no symptoms, After discussion with the pediatric surgeon, the patient was discharged from the hospital and returned for surgery after 6 months. Generally, infants and young children without any symptoms can be closely observed until 6 months old before undergoing surgery. However, if there are the following conditions, such as abdominal pain, abnormal liver function, jaundice, or persistent enlargement of common bile duct cyst, surgery is required as soon as possible regardless of age.

The liver is the second largest organ in the human body. It is located in the abdominal cavity, below the diaphragm, and above the stomach and intestines. In addition to producing bile that helps the intestines digest food, the liver also helps the body in many ways: including producing coagulation factors to allow blood to coagulate normally; Proteins that carry oxygen and support the immune system, store extra nutrients, cleanse the blood of harmful substances, and control blood sugar and cholesterol levels.

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A normal liver produces bile to help digest food. When a child has a choledochal cyst (swelling of the common bile duct), bile can back up into the liver, which can cause liver problems or inflammation of the pancreas because it blocks the passage from the pancreas to the intestines. Children with choledochal cysts, the main duct of the duct, have a higher chance of developing bile duct cancer as adults, and early treatment can reduce these risks.

What are the causes of choledochal cyst?

Choledochal cyst is a congenital or acquired disease that slows down the flow of bile from the liver to the small intestine, causing the bile system to “regress” and causing a series of health problems. Most choledochal cysts (about two-thirds) ) will be diagnosed before children are 10 years old. In developed countries, the incidence of choledochal cyst is about one in 100,000 to 150,000, and girls are four times more common than boys. The prevalence of choledochal cyst is higher in East Asia. , the incidence rate in Japan is as high as one in 1,000.

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The congenital cause is that there are fewer ganglion cells in the distal common bile duct in patients with choledochal cyst, leading to proximal dilation of the common bile duct, which is similar to the pathogenesis of achalasia and Hirschsprung disease. The most popular cause of acquired causes is Babbitt’s theory, which states that cysts develop from the abnormal pancreaticobiliary junction (APBJ). APBJ refers to the bile duct and pancreatic duct 1 to 2 centimeters proximal to the Oddi sphincter. The long channels formed are not covered by the sphincter, allowing the backflow and mixing of pancreatic and bile secretions, causing the activation of pancreatic enzymes, causing an increase in pressure, and ultimately leading to dilation of the biliary tree, inflammation, epithelial damage, dysplasia, and malignant tumors.

What are the symptoms of choledochal cyst?

Some choledochal cysts are discovered through ultrasound testing before the child is born. Sometimes after the baby is born, the child’s parents or doctor may notice a mass in the upper right abdomen. Although a child is born with a choledochal cyst, symptoms may appear in the It appears in infancy and may not appear for several years. Infants or older children may develop the following symptoms: abdominal mass, pain in the upper right abdomen, jaundice, nausea and vomiting, fever.

How is choledochal cyst diagnosed?

Choledochal cysts are most commonly diagnosed with ultrasound. In rare cases, the cyst can be diagnosed before birth with prenatal ultrasound. Other imaging tests that can be used to diagnose choledochal cysts include computed tomography and magnetic resonance imaging. Contrast cholangiopancreatography or endoscopic retrograde cholangiopancreatography.

Types and location of choledochal cysts

Choledochal cysts can form in the intrahepatic (intrahepatic) or extrahepatic (outside the liver) portion of the bile duct. There are five basic types of choledochal cysts, depending on where they occur:

Type I: the most common type (80-90%) involving cystic or fusiform dilation of part or the entire common bile duct with normal intrahepatic ducts, Type II: isolated diverticulum protruding from the common bile duct, Type III Or choledochocele: caused by dilation of the duodenal part of the common bile duct or the junction of the pancreatic duct, type IVa: characterized by multiple dilations of the intrahepatic and extrahepatic biliary trees, type IVb: involving only the extrahepatic bile ducts Multiple dilations, type V or Carroll’s disease: cystic dilation of the intrahepatic bile ducts.

How is choledochal cyst treated?

Children with choledochal cysts require surgical resection, either a lobe of the liver if the cyst is intrahepatic or a portion of the duct outside the liver if the cyst is extrahepatic. The procedure also involves biliary reconstruction using a segment of intestine. Minimally invasive surgery (MIS), which has been developed in recent years, is performed through small incisions using small surgical tools and a camera or telescope. MIS can often reduce pain, reduce scarring, and speed up recovery time. It is a form of MIS used to remove choledochal cysts. Called laparoscopic surgery, the surgeon uses small instruments guided by a small telescope to control their movements while watching them on a video screen. With this technique, children can go home within one to two days and resume normal activities more quickly than children who undergo open surgery.

Other benefits of minimally invasive surgery include very small scars, much less postoperative pain, and shorter hospital stays. Without surgery, children with choledochal cysts are at continued risk for other problems: such as bile duct obstruction, bile duct infection, jaundice, cirrhosis, and, in adulthood, choledochal cysts can become cancerous if left untreated.

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