Paediatric Radiology

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Answer : Type I choledochal cyst

Choledochal cyst is not a true cyst but is actually a cystic dilatation of the common bile duct, seen commonly in females and orientals. The favoured aetiology is that of an anomalous insertion of the CBD into the pancreatic duct, permitting reflux of pancreatic juice into the CBD leading to cholangitis and dilatation. Patients present in the first decade of life with pain, intermittent jaundice and a palpable mass in 20-25% cases.

Five basic types have been described : Type I : cystic dilatation of CBD without involvement of gall bladder / cystic duct, type II : CBD diverticulum, type III : choledocholcele, typer IV : intra and extra hepatic cysts, and type V : intra hepatic cysts only (Caroli's disease).

Prompt surgery is indicated to avert possible complications of portal hypertension, cirrhosis, cholangitis, perforation, sepsis and stone formation; excision of cyst and Roux en Y choledochoenterostomy is the preferred surgical management.

Contribution :Dr Sanjeev Mani, Dr Chokhani, Dr N Nanavati, from Mumbai, India