# Choledochal Cyst / Biliary — GCMD Library living collection Also covered as: choledochal cyst · pancreatitis · cholangitis · type 1 choledochal cyst · abdominal pain · type IV choledochal cyst · right upper quadrant pain · intrahepatic ductal dilation Experts: Dr. Ellen Encisco, Dr. Alex Bondoc, Dr. Mark Wulkan, Dr. Luzia Toselli Updated: n/a · 5 episodes · 128 cited statements ## Episodes ### Foundations - [Choledochal Cyst Podcast](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310) — podcast · 22:07 · [machine version](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310.md) - [Choledochal Cysts: In Brief with Dr. Alexander Bondoc](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439) — podcast · 16:55 · [machine version](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439.md) ### Evidence & Research - [Outcomes of laparoscopic versus open resection of pediatric choledochal cyst](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640.md) - [Journal of pediatric surgery Article Review: April 2023, IPEG issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959) — podcast · 13:22 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959.md) - [Quick Literature Updates Episode 15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927) — video · 4:12 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=0) Definition, Epidemiology, and Classification (Ep 1) - [3:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=200) Clinical Presentation and Differential Diagnosis (Ep 1) - [6:44](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=404) Diagnostic Workup and Indications for Surgery (Ep 1) - [9:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=552) Preoperative Planning and Surgical Goals (Ep 1) - [13:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=796) Surgical Technique (Ep 1) - [18:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1120) Postoperative Management and Long-Term Outcomes (Ep 1) - [0:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0) Introduction and Classification (Ep 2) - [3:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=180) Clinical Presentation and Workup (Ep 2) - [7:23](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=443) Indications for Surgery and Preoperative Planning (Ep 2) - [12:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728) Surgical Technique and Postoperative Management (Ep 2) - [0:00](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=0) Study overview: open vs laparoscopic choledochal cyst resection (Ep 3) - [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=0) Introduction and Titanic Index Overview (Ep 4) - [2:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120) Titanic Index Study Details and Clinical Application (Ep 4) - [5:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=316) Button Battery Ingestion Risk Factors (Ep 4) - [8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534) Choledochal Cyst Resection Approaches (Ep 4) - [11:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=689) Summary and Closing (Ep 4) - [0:09](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=9) Introduction and First Paper Overview (Ep 5) - [0:59](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=59) Hirschsprung-Associated IBD Risk Factors (Ep 5) - [1:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=104) Choledochal Cyst Resection Outcomes (Ep 5) - [2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=170) Solid Organ Injury Discharge Criteria (Ep 5) - [3:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=236) Closing (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "The study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018." — Ellen Encisco (epidemiological) [Ep 3 · 0:13](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=13) - "The majority of patients underwent open resection." — Ellen Encisco (epidemiological) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24) - "Patients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy." — Ellen Encisco (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24) - "Patients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy." — Ellen Encisco (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=24) - "Patients who underwent open resection were more likely to have a longer length of hospital stay." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39) - "Patients who underwent open resection were more likely to have more complications." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39) - "Patients who underwent open resection had higher total costs." — Ellen Encisco (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/outcomes-of-laparoscopic-versus-open-resection-of-pediatric-choledochal-cyst-6640?t=39) - "The Hirschsprung-associated IBD study was retrospective, gathering patients from 2000 to 2021 at 17 institutions" — Cecilia Gigena (epidemiological) [Ep 5 · 0:59](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=59) - "The study identified 55 Hirschsprung patients, with 50% having long segment disease" — Cecilia Gigena (epidemiological) [Ep 5 · 1:14](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=74) - "68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis" — Cecilia Gigena (epidemiological) [Ep 5 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79) - "10% of the Hirschsprung patients had trisomy 21" — Cecilia Gigena (epidemiological) [Ep 5 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79) - "Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 are potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through" — Cecilia Gigena (clinical) [Ep 5 · 1:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=79) - "The choledochal cyst study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018" — Ellen Encisco (epidemiological) [Ep 5 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=131) - "The majority of choledochal cyst patients underwent open resection" — Ellen Encisco (epidemiological) [Ep 5 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141) - "Patients who underwent open choledochal cyst resection were more likely to have a Roux-en-Y hepaticojejunostomy" — Ellen Encisco (clinical) [Ep 5 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141) - "Patients who underwent laparoscopic choledochal cyst resection were more likely to have a hepaticoduodenostomy" — Ellen Encisco (clinical) [Ep 5 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=141) - "Patients who underwent open choledochal cyst resection had longer length of hospital stay compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 5 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156) - "Patients who underwent open choledochal cyst resection had more complications compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 5 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156) - "Patients who underwent open choledochal cyst resection had higher total costs compared to laparoscopic resection" — Ellen Encisco (clinical) [Ep 5 · 2:36](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=156) - "The solid organ injury study was retrospective and conducted in South Carolina" — Cecilia Gigena (epidemiological) [Ep 5 · 3:09](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=189) - "The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3" — Cecilia Gigena (epidemiological) [Ep 5 · 3:19](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=199) - "148 patients had solid organ injuries grades 1 or 2, and none required acute intervention" — Cecilia Gigena (clinical) [Ep 5 · 3:26](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=206) - "Of 114 patients with grade 3 solid organ injuries, only 3 required acute intervention" — Cecilia Gigena (clinical) [Ep 5 · 3:34](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=214) - "Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department" — Cecilia Gigena (clinical) [Ep 5 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-15-7927?t=224) - "Choledochal cysts are a congenital dilation of the biliary tree" (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=0) - "Choledochal cysts have a female predominance" (epidemiological) [Ep 2 · 1:14](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=74) - "In the Western world the incidence is about one in 100,000" (epidemiological) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=82) - "In Asia specifically Eastern Asia the incidence is one in 13,000" (epidemiological) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=95) - "The Todani classification categorizes choledochal cysts as types one through five" (clinical) [Ep 2 · 1:48](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=108) - "Types one and four are likely embryologic relating to the pancreaticobiliary duct junction also known as pancreaticobiliary malunion" (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=125) - "In adults the common channel is supposed to be less than 0.9 centimeters" (clinical) [Ep 2 · 2:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=155) - "In the pediatric patient any common channel is abnormal" (clinical) [Ep 2 · 2:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=170) - "Type 5 cyst otherwise known as Caroli's disease has an associated genetic gene mutation in PKHD1" (clinical) [Ep 2 · 2:58](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=178) - "Type 1 is a dilation of the common bile duct only, the extrahepatic common bile duct only and that can either be fusiform or saccular" (clinical) [Ep 2 · 3:18](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=198) - "Type 2 choledochal cyst is just a small diverticulum off of the common bile duct" (clinical) [Ep 2 · 3:45](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=225) - "Type 3 or a choledochocele is a dilation of the common bile duct in the wall of the duodenum" (clinical) [Ep 2 · 3:58](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=238) - "Type 4a is a multitude of cysts both in the intra and extrahepatic biliary tree" (clinical) [Ep 2 · 4:12](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=252) - "Type 4b are multiple cysts but in the extrahepatic biliary tree only" (clinical) [Ep 2 · 4:28](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=268) - "Type 5 otherwise known as Caroli's disease has diffuse cystic dilation" (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=280) - "In younger children such as infants choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound imaging" (clinical) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=295) - "In children patients often get symptoms consistent with cholangitis such as jaundice or fever" (clinical) [Ep 2 · 5:18](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=318) - "Patients can have a palpable right upper quadrant mass" (clinical) [Ep 2 · 5:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=335) - "Giant cysts that children are born with can actually perforate and present with biliary ascites" (clinical) [Ep 2 · 5:45](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=345) - "Large choledochal cysts can be identified on a 20-week fetal ultrasound" (clinical) [Ep 2 · 6:05](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=365) - "If a cyst was diagnosed prenatally and it was larger than four and a half centimeters at the 20-week anatomy scan there was a higher rate of postnatal symptomatology" (clinical) [Ep 2 · 6:18](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=378) - "In infants a liver biopsy is needed to rule out the cystic biliary atresia variant" (clinical) [Ep 2 · 6:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=410) - "Axial imaging such as a CT scan is needed before taking these kids to the operating room" (clinical) [Ep 2 · 7:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=428) - "MRCP may be useful for operative planning if there are questions about anatomic details specifically high disease into the hilum or intrahepatic" (clinical) [Ep 2 · 7:23](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=443) - "Up to 15 to 20 percent of patients have some kind of variant biliary tract anatomy" (clinical) [Ep 2 · 7:50](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=470) - "The risk for developing cholangiocarcinoma can be as high as 26 percent" — Alex Bondoc (clinical) [Ep 2 · 8:03](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=483) - "Even after surgical resection of these cysts some studies suggest there is still about a four percent lifetime risk of malignancy" — Alex Bondoc (clinical) [Ep 2 · 8:22](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=502) - "Patients presenting acutely can have pancreatitis or cholangitis" — Alex Bondoc (clinical) [Ep 2 · 8:45](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=525) - "For type 1 and type 4 cysts the goal is to remove as much of the duct as possible taking the duct all the way down to where it tapers behind the head of the pancreas or into the head of the pancreas" — Alex Bondoc (clinical) [Ep 2 · 8:58](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=538) - "Reconstruction can include a hepaticoduodenostomy or a hepaticojejunostomy" — Alex Bondoc (clinical) [Ep 2 · 9:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=580) - "For Roux-en-Y hepaticojejunostomy reconstruction, go about 15 to 20 centimeters distal from the ligament of Treitz" (clinical) [Ep 2 · 12:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=728) - "Perform hepaticojejunostomy with interrupted absorbable suture, usually 5-0 or 6-0 Maxon" (clinical) [Ep 2 · 12:30](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=750) - "Type 2 choledochal cysts require a resection of the diverticulum and a primary repair of the common bile duct" (clinical) [Ep 2 · 12:48](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=768) - "For type 3 cysts ERCP and sphincterotomy can be therapeutic in some cases" (clinical) [Ep 2 · 13:08](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=788) - "If type 3 lesion is large and obstructing the common duct you have to go transduodenal to resect the cyst" (clinical) [Ep 2 · 13:25](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=805) - "Type 5 may require a liver transplant if the cystic disease is diffuse throughout the liver" (clinical) [Ep 2 · 13:48](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=828) - "If the cystic burden in type 5 is limited to one side of the hemi liver you can address it surgically with a liver resection" (clinical) [Ep 2 · 14:10](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=850) - "Postoperatively patients have an NG tube for about 24 hours to protect the new jejunal anastomosis" (clinical) [Ep 2 · 14:35](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=875) - "Patients have temporary biliary drains until they're eating a regular diet to catch any leaks from the hepaticojejunostomy" (clinical) [Ep 2 · 14:55](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=895) - "Postoperative complications include recurrent cholangitis due to the connection between the biliary tree and the enteric system" (clinical) [Ep 2 · 15:18](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=918) - "Surgical complications can include anastomotic stricture, small bowel obstruction, and reflux gastritis" (clinical) [Ep 2 · 15:40](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=940) - "Prophylactically patients are put on Bactrim postoperatively" (clinical) [Ep 2 · 15:58](https://library.globalcastmd.com/watch/choledochal-cysts-in-brief-with-dr-alexander-bondoc-5439?t=958) - "The Titanic Index measures the percentage of sternum that lies under the anterior costal line" — Luzia Toselli (clinical) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120) - "The study included 78 patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars" — Luzia Toselli (clinical) [Ep 4 · 2:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=132) - "A Titanic Index cutpoint of 66.5% predicted need for more than two implants with 93% sensitivity and 92% specificity" — Luzia Toselli (clinical) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=180) - "Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture" — Ellen Encisco (clinical) [Ep 4 · 5:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=336) - "The Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes" — Ellen Encisco (epidemiological) [Ep 4 · 6:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=365) - "Three predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms" — Ellen Encisco (clinical) [Ep 4 · 6:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=380) - "Time to removal was not a significant predictor of severe outcomes in the button battery series" — Farokh Demeri (clinical) [Ep 4 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=444) - "The choledochal cyst study analyzed 577 patients aged 0-21 years from 2016 to 2018 in a national database" — Chad Thorson (epidemiological) [Ep 4 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534) - "28% of choledochal cyst procedures were done laparoscopically and the rest were done open" — Chad Thorson (epidemiological) [Ep 4 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534) - "Most open procedures for choledochal cysts were hepaticojejunostomy and most laparoscopic procedures were hepaticoduodenostomy" — Chad Thorson (clinical) [Ep 4 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534) - "Patients receiving open operations had inferior outcomes including longer length of stay, higher cost, more TPN use, and more central line requirements" — Chad Thorson (clinical) [Ep 4 · 9:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567) - "There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection" — Mark Wulkan (clinical) [Ep 4 · 10:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=632) - "Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance" (opinion) [Ep 4 · 10:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=654) - "Choledochal cyst is a congenital cystic dilation of the biliary tree" — Alex Bondoc (clinical) [Ep 1 · 0:29](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=29) - "In the Western world, the incidence is about 1 in 100,000" — Alex Bondoc (epidemiological) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=36) - "In Asia, specifically Eastern Asia, incidence is 1 in 13,000" — Alex Bondoc (epidemiological) [Ep 1 · 0:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=50) - "Choledochal cysts are three to four times more likely in females than in males" — Alex Bondoc (epidemiological) [Ep 1 · 0:58](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=58) - "There are some genes that have been identified in limited studies, possibly including PKD1 for type 5 choledochal cysts" — Alex Bondoc (clinical) [Ep 1 · 0:58](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=58) - "For types 1 and 4, etiology is likely embryologic, relating to the pancreaticobiliary duct junction (pancreaticobiliary malunion), which creates a long common channel" — Alex Bondoc (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=70) - "Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration, and epithelial changes" — Alex Bondoc (clinical) [Ep 1 · 1:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=100) - "Type 1 is a dilation of the extrahepatic common bile duct only, either fusiform or saccular" — Alex Bondoc (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=125) - "Type 2 is a small diverticulum off of the common bile duct" — Alex Bondoc (clinical) [Ep 1 · 2:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=145) - "Type 3 is a choledochocele affecting the portion of the common bile duct in the wall of the duodenum" — Alex Bondoc (clinical) [Ep 1 · 2:35](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=155) - "Type 4a is multiple cysts in both the intra- and extrahepatic biliary tree; type 4b is multiple cysts in the extrahepatic biliary tree only" — Alex Bondoc (clinical) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=165) - "Type 5 is intrahepatic only and diffusely throughout, called Caroli's disease" — Alex Bondoc (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=180) - "In younger children such as infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes" — Alex Bondoc (clinical) [Ep 1 · 3:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=205) - "In children, patients often present with symptoms consistent with cholangitis, such as jaundice or fever, and can have a palpable right upper quadrant mass" — Alex Bondoc (clinical) [Ep 1 · 3:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=225) - "Charcot's triad (jaundice, fever, palpable RUQ mass) is incredibly uncommon as a presentation" — Alex Bondoc (clinical) [Ep 1 · 4:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=245) - "Giant cysts that children are born with can perforate and present with biliary ascites" — Alex Bondoc (clinical) [Ep 1 · 4:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=260) - "Giant choledochal cysts can be diagnosed prenatally on week 20 ultrasounds" — Alex Bondoc (clinical) [Ep 1 · 4:35](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=275) - "If a cyst was diagnosed prenatally and was larger than 4.5 cm at the 20-week anatomy scan, there was a higher rate of postnatal symptomatology, suggesting these patients may benefit from earlier intervention" — Alex Bondoc (clinical) [Ep 1 · 4:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=285) - "Differential diagnosis for a one-year-old with jaundice includes choledocholithiasis, cholelithiasis, gallstone pancreatitis, choledochal cyst, and biliary atresia (though the child is a little old for biliary atresia)" — Alex Bondoc (clinical) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=312) - "Physical exam should look for jaundice or scleral icterus and a palpable abdominal mass in younger children" — Alex Bondoc (clinical) [Ep 1 · 5:46](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=346) - "Labs to check include liver function tests with total, direct, and indirect bilirubin levels, plus or minus a CBC to look for evidence of cholangitis or infection" — Alex Bondoc (clinical) [Ep 1 · 6:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=365) - "The major initial screening imaging test is an abdominal ultrasound" — Alex Bondoc (clinical) [Ep 1 · 6:22](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=382) - "A liver biopsy is not typically needed if the patient is older and you have reliable ultrasound imaging, but becomes critical in a neonate or newborn to rule out cystic biliary atresia" — Alex Bondoc (clinical) [Ep 1 · 6:25](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=385) - "CT scan is commonly used because of the ease with which you can scan young children" — Alex Bondoc (clinical) [Ep 1 · 6:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=407) - "MRCP is useful if there are questions about anatomic details, specifically hilar or intrahepatic disease, to understand how extensive the cystic change is and to identify variant biliary anatomy (present in 15-20% of patients)" — Alex Bondoc (clinical) [Ep 1 · 7:05](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=425) - "ERCP can be both diagnostic and therapeutic depending on what is seen on prior scans and the type of choledochal cyst" — Alex Bondoc (clinical) [Ep 1 · 7:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=460) - "There are no non-surgical treatment options for choledochal cysts" — Alex Bondoc (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=480) - "The anomalous anatomy related to the cyst puts the patient at risk for episodes of cholangitis due to biliary stasis and superinfection, which can be life-threatening" — Alex Bondoc (clinical) [Ep 1 · 8:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=490) - "For type 1 and type 4 cysts with pancreaticobiliary malunion, there is about an 8% lifetime risk of hepatobiliary malignancy, most specifically cholangiocarcinoma and gallbladder cancer" — Alex Bondoc (clinical) [Ep 1 · 8:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=510) - "Studies estimate lifetime malignancy risk anywhere from 6% to 30%" — Alex Bondoc (epidemiological) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=540) - "Even after surgical resection of these cysts, some studies suggest there is still about a 4% lifetime risk of malignancy, requiring lifelong surveillance" — Alex Bondoc (clinical) [Ep 1 · 9:08](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=548) - "If a patient presents actively infected with pancreatitis, cholangitis, or in some acute way, cool them off and treat the underlying process, then schedule surgery after sufficient recovery" — Alex Bondoc (clinical) [Ep 1 · 9:16](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=556) - "For incidentally found lesions, schedule surgery sooner than later when it makes sense for the family schedule, but not waiting too long" — Alex Bondoc (opinion) [Ep 1 · 9:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=590) - "Surgical goals for type 1 and type 4 are to remove as much of the duct as possible, taking the duct all the way down behind or into the head of the pancreas to where it tapers, so as not to leave remnant cyst" — Alex Bondoc (clinical) [Ep 1 · 11:13](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=673) - "For type 1 and type 4 cysts, reconstruction of the biliary drainage system often includes a Roux-en-Y hepaticojejunostomy, but a hepaticoduodenostomy is also an option" — Alex Bondoc (clinical) [Ep 1 · 11:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=710) - "Type 2 can be simply removal of the diverticulum at its neck with repair of the common bile duct" — Alex Bondoc (clinical) [Ep 1 · 12:15](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=735) - "Type 3 can be treated with ERCP and sphincterotomy if it is a limited choledochocele, or transduodenal resection if it involves the duodenal wall" — Alex Bondoc (clinical) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=750) - "Biopsy of the mucosa of the choledochocele is important because if it is biliary epithelium constantly exposed to intestinal secretions, it could become malignant" — Alex Bondoc (clinical) [Ep 1 · 12:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=770) - "Type 5 management depends on how diffuse the disease is: if limited to an anatomic part of the liver, resection may be possible; if diffuse throughout with inadequate functional liver remnant, transplantation may be necessary" — Alex Bondoc (clinical) [Ep 1 · 13:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=790) - "In a younger child (less than 2 years), a transverse or right subcostal incision is preferred; in older children, an upper midline incision is also viable" — Alex Bondoc (clinical) [Ep 1 · 13:19](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=799) - "Intraoperative cholangiogram through the gallbladder helps understand where the tapering of the distal cyst occurs to avoid leaving remnant cyst" — Alex Bondoc (clinical) [Ep 1 · 14:40](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=880) - "Roux-en-Y limb is constructed about 15 to 20 cm distal from the ligament of Treitz, brought retrocolic, and hepaticojejunostomy is performed with interrupted 5-0 or 6-0 Maxon suture" — Alex Bondoc (clinical) [Ep 1 · 15:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=950) - "For type 2 cyst, resect the neck and repair the common bile duct with interrupted absorbable suture; T-tube is not typically left" — Alex Bondoc (clinical) [Ep 1 · 16:47](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1007) - "Type 3 cyst can be approached endoscopically with ERCP and sphincterotomy, or transduodenally if large and obstructing, sometimes with preoperative stents" — Alex Bondoc (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1050) - "Type 5 (Caroli's disease) management depends on extent: if limited to one hemi-liver with adequate remnant and preserved biliary outflow, liver resection is possible; if diffuse, liver transplantation may be necessary" — Alex Bondoc (clinical) [Ep 1 · 18:10](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1090) - "Postoperatively, place drains to assess for biliary leaks from the hepatoenteric anastomosis and remove them once the patient is tolerating a regular diet" — Alex Bondoc (clinical) [Ep 1 · 18:45](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1125) - "Institutionally, patients are placed on a choleretic like Actigall and cholangitis prophylaxis with daily Bactrim for 3 to 6 months after surgery" — Alex Bondoc (clinical) [Ep 1 · 19:20](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1160) - "Short-term to long-term surgical complications can include anastomotic stricture, small bowel obstruction, reflux gastritis, and recurrent cholangitis" — Alex Bondoc (clinical) [Ep 1 · 19:50](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1190) - "Lifelong follow-up is needed because of the possibility of developing future malignancy even after resection of the cyst" — Alex Bondoc (clinical) [Ep 1 · 20:15](https://library.globalcastmd.com/watch/choledochal-cyst-podcast-3310?t=1215) ## Common questions ### How is a choledochal cyst diagnosed? Choledochal cysts are diagnosed through imaging modalities. In infants and younger children, they are often discovered incidentally on axial imaging or ultrasound performed for other reasons. Giant choledochal cysts can be identified prenatally on 20-week fetal ultrasounds. ERCP can serve as both a diagnostic and therapeutic tool depending on findings from prior imaging and cyst type. ## Changelog - Aug 31: 10 doctors auto-found from episode dossiers - Aug 30: 4 doctors auto-found from episode dossiers - Aug 30: 4 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 5 doctors auto-found from episode dossiers - Aug 29: 5 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 14 items, 8 dossiers, summaries for 2 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 8 items, 8 dossiers, summaries for 1 audience(s) - Aug 29: Collection generated from campaign corpus: 8 items, 8 dossiers, summaries for 2 audience(s) - Aug 29: Collection generated from campaign corpus: 8 items, 8 dossiers, summaries for 1 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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