What is a Choledochal Cyst?

A choledochal cyst is a congenital or acquired cystic dilation of the bile duct system. It can involve the extrahepatic bile duct, intrahepatic ducts, or both. The condition is more common in Asia and in females. If untreated, it carries a significant risk of cancer development in the cyst wall.

Symptoms

• Jaundice (yellow skin and eyes) — intermittent or persistent
• Abdominal pain — right upper quadrant
• Palpable abdominal mass (in children)
• Recurrent cholangitis (fever, jaundice, pain)
• Pancreatitis — due to associated anomalous pancreaticobiliary junction
• Incidental finding on ultrasound or CT scan

Diagnosis

• Ultrasound abdomen — initial investigation; shows cystic dilation of bile duct
• MRCP (Magnetic Resonance Cholangiopancreatography) — best non-invasive investigation; defines cyst type and anatomy
• CT scan — for detailed anatomy and surgical planning
• ERCP — diagnostic and therapeutic in selected cases

Why Surgery is Essential

Complete surgical excision is mandatory because untreated choledochal cysts carry a lifetime malignancy risk of 10–30% (cholangiocarcinoma). This risk increases with age. Surgery also relieves symptoms and prevents recurrent cholangitis and pancreatitis. The standard operation — cyst excision with Roux-en-Y hepaticojejunostomy — is performed by Dr. Ashok Kumar at Charak Hospital.