Cystic duct cyst: Need for new classification ?
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91 Hellenic Journal of Surgery 2013; 85: 2
Cystic Duct Cyst: Need for New Classification ? Case Report S. Tzedakis, A. Mamantopoulos, E. Androulidakis, E. Kostantoulakis, I. Papadakis, G. Branakis, G. Tzanoudakis, S. Paparidis Received 04/12/2012 Accepted 12/01/2013
Abstract Aim-Background: Choledochal cysts are rare entities presenting as cystic dilatations of the biliary tree. Even though their origin is uncertain, they are usually referred for removal because of malfunction of the biliary tract as well as their association with developing malignancy. Traditionally, these choledochal cysts are classified under 5 main types. A condition that is even rarer, the cystic duct cyst, is not included in this classification. We describe such a case of a cyst of the cystic duct that was successfully removed via laparoscopy. Material-Method: A 32-year-old patient is described who was admitted to the hospital complaining of symptoms consistent with acute cholecystitis and associated with signs of biliary tract obstruction. Following imaging investigation with MRI, a cystic duct malformation was revealed and further surgical treatment was planned. Results-Conclusion: Our case shows that even though cystic duct cysts are extremely rare, they are a clinical entity that cannot be ignored and needs to be recognized. Given the existence of similar case reports in literature and the similarity of cystic duct cysts with other choledochal cysts, a new category in the Todani classification may be considered so that clinicians are prepared for this ‘Type VI’ cystic variant.
Key words:
Biliary tree, Cystic duct, Choledochal cyst, Cystic duct cyst
Introduction Congenital dilatation of the extrahepatic biliary tract, with or without concurrent intrahepatic biliary tract dilatation, is referred to as a choledochal cyst [1]. Cysts of the main biliary tract have been
S. Tzedakis (Corresponding author) A. Mamantopoulos, E. Androulidakis, E. Kostantoulakis, I. Papadakis, G. Branakis, G. Tzanoudakis, S. Paparidis - General Hospital - Health Center of Ierapetra, Department of Surgery Department of Magnetic Resonance Imaging, ‘Iatriko Kritis’ - Ippokrateio General Hospital of Athens, Department of Surgery e-mail: [email protected]
classified under 5 main types, according to the Todani et al [2] classification, which has replaced that of Alonjo et al [3] that classified them under 3 types (fig.1). Type I cyst pertains to the common bile duct; type II is a cystic diverticulum of the common bile duct; type III is a distal dilatation of the common bile duct within the duodenal wall; type IV refers to multiple cysts in the intra- and extrahepatic biliary tract; and type V refers to cysts (multiple or single) arising solely from the intrahepatic ducts (Caroli’s disease).
Fig.1 Todani’s classification for choledochal cysts Cysts that are not included in this classification are cysts of the cystic duct, an extremely rare condition with only 26 cases published in literature to date [4,517]. Patients with choledochal cysts, whether symptomatic or n
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