Choledochal cysts are
rare and usually manifest in infancy and childhood. They are considered
congenital because they occur in fetuses and neonates. Their origin may
be related to an abnormal connection between the pancreatic duct and common
bile duct and chronic reflux of pancreatic juice into the bile duct, resulting
in irritation of the duct and subsequent dilatation. Choledochal cysts
appear as cystic or fusiform dilatation of the common bile duct at radiography.
Ultrasonography is the best initial method of evaluating dilatation of
the intra- and extrahepatic bile ducts. Computed tomography is considered
to be more accurate in delineating the intrahepatic biliary tree. Hepatobiliary
scintigraphy with technetium-99m disofenin provides physiologic information
on hepatic uptake and accumulation of radionuclide in the dilated biliary
tree. Endoscopic retrograde cholangiopancreatography, percutaneous transhepatic
cholangiography, and intraoperative cholangiography are definitive studies
that demonstrate anatomic details of the biliary tree and the pancreaticobiliary
ductal junction.
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