# Choledochal Cysts — GCMD Library living collection

Updated: n/a · 1 episodes · 33 cited statements

## Episodes
### Classification and Diagnosis
- [Choledochal Cysts: Classification, Diagnosis, and Management in Pediatric Patients](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009) — podcast · 16:46 · [machine version](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=0) Introduction and Classification Overview (Ep 1)
- [3:10](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=190) Detailed Todani Classification Types 1-5 (Ep 1)
- [4:14](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=254) Clinical Presentation and Diagnosis (Ep 1)
- [6:01](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=361) Diagnostic Workup and Imaging (Ep 1)
- [8:23](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=503) Complications and Surgical Indications (Ep 1)
- [10:13](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=613) Surgical Technique and Reconstruction (Ep 1)
- [13:59](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=839) Postoperative Management and Long-term Follow-up (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is a type 6 choledochal cyst which is cystic dilation of the cystic duct itself — Alex Bondoc (clinical) [Ep 1 · 0:28](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=28)
- In the Western world, choledochal cyst incidence is about 1 in 100,000 — Alex Bondoc (epidemiological) [Ep 1 · 1:21](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=81)
- In Eastern Asia, choledochal cyst incidence is 1 in 13,000 — Alex Bondoc (epidemiological) [Ep 1 · 1:26](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=86)
- For Todani types 1 and 4, the etiology is likely embryologic, relating to pancreatic biliary duct junction (pancreatic biliary malunion) — Alex Bondoc (clinical) [Ep 1 · 1:48](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=108)
- 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 · 2:37](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=157)
- Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular — Alex Bondoc (clinical) [Ep 1 · 3:18](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=198)
- Type 2 choledochal cyst is a small diverticulum off of the common bile duct — Alex Bondoc (clinical) [Ep 1 · 3:28](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=208)
- Type 4A choledochal cyst has multiple cysts in both the intra and extrahepatic biliary tree — Alex Bondoc (clinical) [Ep 1 · 3:45](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=225)
- Type 4B choledochal cyst has multiple cysts in the extrahepatic biliary tree only — Alex Bondoc (clinical) [Ep 1 · 3:45](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=225)
- Type 5 choledochal cyst (Caroli's disease) has diffuse cystic dilation that can be throughout the liver or limited to one lobe — Alex Bondoc (clinical) [Ep 1 · 4:01](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=241)
- In younger children and infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes — Alex Bondoc (clinical) [Ep 1 · 4:23](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=263)
- In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever — Alex Bondoc (clinical) [Ep 1 · 4:33](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=273)
- Patients with choledochal cysts can have a palpable right upper quadrant mass — Alex Bondoc (clinical) [Ep 1 · 4:42](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=282)
- Giant choledochal cysts that children are born with can perforate and present with biliary ascites — Alex Bondoc (clinical) [Ep 1 · 5:06](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=306)
- If a choledochal cyst diagnosed prenatally is larger than 4.5 centimeters at the 20-week anatomy scan, there is a higher rate of postnatal symptomatology and these patients may benefit from earlier intervention — Alex Bondoc (clinical) [Ep 1 · 5:31](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=331)
- Workup for choledochal cysts includes liver function tests with total, direct and indirect bilirubin levels, plus or minus CBC to look for evidence of cholangitis or infection — Alex Bondoc (clinical) [Ep 1 · 6:05](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=365)
- In infants with suspected choledochal cysts, liver biopsy is critical to rule out cystic biliary atresia variant — Alex Bondoc (clinical) [Ep 1 · 6:35](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=395)
- MRCP is useful for operative planning when there are questions about anatomic details, specifically for high disease into the hilum or intrahepatic involvement — Alex Bondoc (clinical) [Ep 1 · 7:04](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=424)
- Up to 15 to 20% of patients with choledochal cysts have some kind of variant biliary tract anatomy — Alex Bondoc (epidemiological) [Ep 1 · 7:32](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=452)
- Some patients with choledochal cysts will benefit from ERCP for diagnostic and therapeutic purposes, depending on prior scans and the type of cyst — Alex Bondoc (clinical) [Ep 1 · 7:50](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=470)
- Anatomic anomalies of the biliary tract can lead to cholangitis as a significant complication due to biliary stasis and superinfection — Alex Bondoc (clinical) [Ep 1 · 8:23](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=503)
- Even after surgical resection of choledochal cysts, there is about a 4% lifetime risk of malignancy, requiring lifelong surveillance — Alex Bondoc (epidemiological) [Ep 1 · 8:53](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=533)
- If a patient with choledochal cyst presents actively infected with pancreatitis or cholangitis, the best approach is to cool the patient off and treat the underlying process before surgery — Alex Bondoc (clinical) [Ep 1 · 9:20](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=560)
- For type 1 and type 4 choledochal cysts, the surgical goal is to remove as much of the duct as possible, taking it behind or into the head of the pancreas down to where it tapers, to avoid leaving remnant cysts — Alex Bondoc (clinical) [Ep 1 · 10:24](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=624)
- Intraoperative cholangiogram through the gallbladder can be used to identify where the distal cyst taper occurs when imaging is unclear or anatomy is aberrant — Alex Bondoc (clinical) [Ep 1 · 11:04](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=664)
- For type 1 and type 4 choledochal cysts, biliary reconstruction often includes a Roux-en-Y hepaticojejunostomy, though hepaticoduodenostomy is also an option — Alex Bondoc (clinical) [Ep 1 · 11:35](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=695)
- Dr. Bondoc constructs Roux-en-Y hepaticojejunostomies by going 15 to 20 centimeters distal from the ligament of Treitz for the Roux limb, performing a jejunojejunostomy in two layers when size allows, and creating a hepaticojejunostomy with interrupted absorbable suture (5-0 or 6-0 Maxon) — Alex Bondoc (clinical) [Ep 1 · 12:08](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=728)
- Dr. Bondoc closes the mesenteric defect after Roux-en-Y reconstruction but does not usually biopsy the liver unless there is something obvious — Alex Bondoc (clinical) [Ep 1 · 13:07](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=787)
- If a type 3 choledochal cyst is large and obstructing the common duct, transduodenal resection may be required, sometimes with preoperative stents placed via ERCP to identify anatomy — Alex Bondoc (clinical) [Ep 1 · 13:28](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=808)
- For type 5 choledochal cysts, if the cystic burden is limited to one hemiliver allowing adequate liver remnant and preserved biliary outflow, it can be addressed with liver resection — Alex Bondoc (clinical) [Ep 1 · 14:09](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=849)
- If type 5 choledochal cyst disease is diffuse throughout the liver, the patient may need to be evaluated for liver transplantation — Alex Bondoc (clinical) [Ep 1 · 14:30](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=870)
- Short-term to long-term surgical complications after choledochal cyst surgery can include anastomotic stricture, small bowel obstruction, reflux gastritis, and recurrent cholangitis — Alex Bondoc (clinical) [Ep 1 · 15:10](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=910)
- Lifelong follow-up is needed for choledochal cyst patients because there is still a real possibility for future malignancy even after resection of the cyst — Alex Bondoc (clinical) [Ep 1 · 15:56](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=956)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Choledochal cysts are a congenital dilation of the biliary tree — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 0:08](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=8)
- Choledochal cysts have a female predominance — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 1:10](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=70)
- Pancreatic biliary malunion is just one theory for choledochal cyst etiology and doesn't explain the higher incidence in the Far East — The host summarizes what Dr. Alex Bondoc said [Ep 1 · 2:01](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=121)
- In adults, the common channel (confluence of biliary pancreatic ducts) should be less than 0.9 centimeters — The host summarizes what Dr. Alex Bondoc said [Ep 1 · 2:18](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=138)
- In pediatric patients, any common channel is abnormal — The host summarizes what Dr. Alex Bondoc said [Ep 1 · 2:30](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=150)
- Type 5 choledochal cyst (Caroli's disease) has an associated genetic mutation in PKHD1 — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 2:48](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=168)
- Type 3 choledochal cyst (choledochocele) is a dilation of the common bile duct in the wall of the duodenum — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 3:35](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=215)
- Large choledochal cysts can be identified on 20-week fetal ultrasound — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 5:12](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=312)
- Labs plus abdominal ultrasound can be diagnostic for choledochal cysts — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 6:25](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=385)
- CT scan is needed before taking children with choledochal cysts to the operating room — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 6:47](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=407)
- The risk for developing cholangiocarcinoma with untreated choledochal cysts can be as high as 26% according to some studies — The host summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=520)
- Preoperative MRCP is usually enough to identify where the taper behind the pancreas is located — The host summarizes what Dr. Alex Bondoc said [Ep 1 · 10:57](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=657)
- Type 2 choledochal cysts require resection of the diverticulum and primary repair of the common bile duct — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 13:12](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=792)
- For type 3 choledochal cysts, ERCP and sphincterotomy can be therapeutic in some cases — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 13:18](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=798)
- Postoperatively, choledochal cyst patients have an NG tube for about 24 hours to protect the new jejunal anastomosis — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 14:41](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=881)
- Postoperatively, choledochal cyst patients have temporary biliary drains until eating a regular diet to catch any leaks from the hepaticojejunostomy — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 14:41](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=881)
- Choledochal cyst patients have additional postoperative risk for recurrent cholangitis due to the connection between the biliary tree and the enteric system — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 15:02](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=902)
- Prophylactically, choledochal cyst patients are put on Bactrim postoperatively — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 15:40](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=940)
- Actigall can be helpful postoperatively for choledochal cyst patients, though this may be institution-specific — Em Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said [Ep 1 · 15:40](https://library.globalcastmd.com/watch/choledochal-cysts-classification-diagnosis-and-management-in-pediatric-patients-16009?t=940)

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