Diagnosis of Choledochal Cyst

In some cases, a prenatal (pregnancy) ultrasound can reveal your child’s choledochal cyst before birth. If the condition is not diagnosed before birth, a choledochal cyst may be found at any time during childhood. Typically, a choledochal cyst is found when a child visits their pediatrician (doctor who specializes in treating children) for abdominal pain. Your child’s doctor may use one or more of the following tests to make a diagnosis:

• Computerized tomography (CT) scan. This test uses X-ray and specialized computers to create detailed images of your child’s gallbladder, bile ducts and surrounding structures.
• Intraoperative cholangiography. This test uses ultrasound and X-ray to create detailed images of your child’s gallbladder, bile ducts and surrounding structures. The surgeon performs this imaging test at the time of your child’s surgery.
• Ultrasound. This test helps your child’s doctor get a closer look at the gallbladder and determine if your child has a cyst and possibly dilated biliary tree.
• Magnetic resonance cholangiopancreatography (MRCP). This test helps your child’s doctor closely check the tubes that are in the liver and that extend to the pancreas. This is a safe option for more detailed pictures.

Treatments for Choledochal Cyst

If your baby or child has this condition, they will need surgery to remove the cyst or cysts. Having the cysts removed at a young age can reduce your child’s risk of developing bile duct cancer in later life. For this reason, your child may either be monitored for a period of time with repeat imaging, or surgery may be scheduled soon after your child is diagnosed with this condition.

In most cases, your child’s surgeon will approach this operation with a minimally invasive technique called laparoscopic surgery. For the surgery, your child will be under general anesthesia (fully asleep). To begin, the surgeon will make tiny incisions (cuts) in your child’s abdomen. They then will insert a tiny camera into one hole and thin surgical tools into the others.

Your child’s surgeon will use a monitor to see inside your child’s abdomen using the surgical camera. The surgeon will remove the cyst or cysts with the surgical tool through one of the incisions. This may involve other surgical procedures as deemed necessary, such as a liver biopsy or a cholangiogram (contrast in the biliary tree). The surgeon will then make a connection between the liver structures and the intestines to allow for bile flow. After removal, the surgeon will close the incisions with stitches and bandages.

Your child will spend several hours in a recovery area. The care team will carefully monitor your child as they wake up from the anesthesia. An intravenous (IV) line will supply fluids through a vein to help keep your child hydrated and avoid dehydration. Once your child begins showing signs of progress (such as bowel function) and they are cleared by the surgical team, they will be able to drink clear liquids and, later, solid foods.

Your child will spend a minimum of three to five days in our hospital following the surgery. During this time, they may receive medicines to reduce the risk of infection and/or manage any pain. Your child will typically see their surgeon for a post-operative appointment and then again around six weeks after their procedure. After that, your child will see their gastroenterologist for routine lab work and monitoring.