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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, Choledochal Cysts: Classification, Diagnosis, and Management in Pediatric Patients · 15:10
Choledochal Cysts: Classification, Diagnosis, and Management in Pediatric Patients
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Are you having difficulty keeping the 5 types of choledochal cyst straight? Each has unique anatomy and management principles. Join Dr. Alexander Bondoc in an overview of Choledochal Cysts for the surgical trainee.
podcast16:46 · Oct 2026
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Choledochal Cysts: Classification, Diagnosis, and Management in Pediatric Patients
Choledochal cysts are a congenital dilation of the biliary tree
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position0:08 ↗
There is a type 6 choledochal cyst which is cystic dilation of the cystic duct itself
clinicalAlex Bondoc0:28 ↗
Choledochal cysts have a female predominance
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position1:10 ↗
In the Western world, choledochal cyst incidence is about 1 in 100,000
epidemiologicalAlex Bondoc1:21 ↗
In Eastern Asia, choledochal cyst incidence is 1 in 13,000
epidemiologicalAlex Bondoc1:26 ↗
For Todani types 1 and 4, the etiology is likely embryologic, relating to pancreatic biliary duct junction (pancreatic biliary malunion)
clinicalAlex Bondoc1:48 ↗
Pancreatic biliary malunion is just one theory for choledochal cyst etiology and doesn't explain the higher incidence in the Far East
Host summaryThe host summarizes what Dr. Alex Bondoc said — not the host's own clinical position2:01 ↗
In adults, the common channel (confluence of biliary pancreatic ducts) should be less than 0.9 centimeters
Host summaryThe host summarizes what Dr. Alex Bondoc said — not the host's own clinical position2:18 ↗
In pediatric patients, any common channel is abnormal
Host summaryThe host summarizes what Dr. Alex Bondoc said — not the host's own clinical position2:30 ↗
Reflux of pancreatic enzymes from the head of the pancreas back into the biliary tree causes inflammation, degeneration and epithelial changes
clinicalAlex Bondoc2:37 ↗
Type 5 choledochal cyst (Caroli's disease) has an associated genetic mutation in PKHD1
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position2:48 ↗
Type 1 choledochal cyst is a dilation of the extrahepatic common bile duct only, which can be fusiform or saccular
clinicalAlex Bondoc3:18 ↗
Type 2 choledochal cyst is a small diverticulum off of the common bile duct
clinicalAlex Bondoc3:28 ↗
Type 3 choledochal cyst (choledochocele) is a dilation of the common bile duct in the wall of the duodenum
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position3:35 ↗
Type 4A choledochal cyst has multiple cysts in both the intra and extrahepatic biliary tree
clinicalAlex Bondoc3:45 ↗
Type 4B choledochal cyst has multiple cysts in the extrahepatic biliary tree only
clinicalAlex Bondoc3:45 ↗
Type 5 choledochal cyst (Caroli's disease) has diffuse cystic dilation that can be throughout the liver or limited to one lobe
clinicalAlex Bondoc4:01 ↗
In younger children and infants, choledochal cysts are often diagnosed incidentally on axial imaging or ultrasound for other causes
clinicalAlex Bondoc4:23 ↗
In children, choledochal cysts often present with symptoms consistent with cholangitis, such as jaundice or fever
clinicalAlex Bondoc4:33 ↗
Patients with choledochal cysts can have a palpable right upper quadrant mass
clinicalAlex Bondoc4:42 ↗
Giant choledochal cysts that children are born with can perforate and present with biliary ascites
clinicalAlex Bondoc5:06 ↗
Large choledochal cysts can be identified on 20-week fetal ultrasound
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position5:12 ↗
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
clinicalAlex Bondoc5:31 ↗
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
clinicalAlex Bondoc6:05 ↗
Labs plus abdominal ultrasound can be diagnostic for choledochal cysts
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:25 ↗
In infants with suspected choledochal cysts, liver biopsy is critical to rule out cystic biliary atresia variant
clinicalAlex Bondoc6:35 ↗
CT scan is needed before taking children with choledochal cysts to the operating room
Host summaryEm Gootee or Todd Ponsky summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:47 ↗
MRCP is useful for operative planning when there are questions about anatomic details, specifically for high disease into the hilum or intrahepatic involvement
clinicalAlex Bondoc7:04 ↗
Up to 15 to 20% of patients with choledochal cysts have some kind of variant biliary tract anatomy
epidemiologicalAlex Bondoc7:32 ↗
Some patients with choledochal cysts will benefit from ERCP for diagnostic and therapeutic purposes, depending on prior scans and the type of cyst
clinicalAlex Bondoc7:50 ↗
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