Choledochal cystectomy to prevent cancer

Ms. Lien discovered a cyst in the common bile duct 23 years ago and refused surgery to remove the cyst. Recently, she had continuous pain in the right lower quadrant of her abdomen, so she went to Tam Anh General Hospital in Ho Chi Minh City for a check-up. The endoscopy results showed a 4 cm large cyst in the common bile duct. The normal size of the common bile duct is about 0.4-0.6 cm. The large cyst caused the duct to dilate to 3.8 cm, 8 times larger than normal, and adhered to surrounding organs. There was also a 2.5 x 1 cm stone in the common bile duct.

On July 5, Dr. Do Minh Hung, Director of the Center for Endoscopy and Endoscopic Surgery of the Digestive System, said that Ms. Lien had a type 1C choledochal cyst, a type of extrahepatic bile duct dilatation. Choledochal cysts are divided into 5 types, depending on shape and location. If not operated on, the patient is at risk of bile duct cancer due to the choledochal cyst leading to the formation of stones causing bile obstruction, pancreatitis…

Ms. Lien was assigned to have laparoscopic surgery to remove the common bile duct cyst, gallbladder, and connect the common hepatic duct to the jejunum (the first part of the small intestine). During the surgery, the doctor noted that the gallbladder was distended, the common bile duct cyst was large, and the omentum was adherent to the gallbladder and common bile duct. The inflamed cyst adhered very tightly to the surrounding tissue and portal vein.

“This is a very difficult surgery due to the many inflammatory adhesions in the organs,” said Master, Doctor Ngo Hoang Kien Tam, Center for Endoscopy and Endoscopic Surgery of the Digestive System, adding that the adhesions need to be carefully removed to avoid damaging the surrounding organs (duodenum, pancreas and blood vessels).

After removing the cyst and gallbladder, the doctor took the small intestine to create a shape, connecting the common hepatic duct to the jejunum. The common bile duct cyst after removal was 4×7 cm in size. After surgery, the patient recovered well, no more abdominal pain, ate and walked normally, and was expected to be discharged after three days, with a follow-up appointment.

According to Dr. Minh Hung, endoscopic surgery helps control every small operation, avoids tissue damage, patients have less pain and recover quickly.

Choledochal cysts are abnormal malformations of the biliary system. Choledochal cysts form due to weakening of the bile duct wall or narrowing of the distal bile duct. Cysts can cause complications such as gallstones, cholecystitis, liver abscess, pancreatitis, cyst rupture, cirrhosis, and bile duct cancer.

Currently, there are many hypotheses to explain the pathogenesis of choledochal cysts. Among them, the hypothesis of a long common pancreatic-biliary canal is the most accepted. This is the reason why pancreatic juice from the pancreas can reflux into the bile duct, causing the bile duct to be damaged and easily dilated.

The disease is common in children, rare in adults, and is discovered by chance during an ultrasound or when symptoms of abdominal pain and jaundice appear. Symptoms of the disease can appear early in childhood, and the patient can still live normally for many years until complications appear. Typical symptoms are abdominal pain, jaundice, and sometimes a palpable mass in the right lower rib cage…

Dr. Hung recommends that patients with choledochal cysts should be diagnosed and operated on early at any age, even if there are no symptoms, to prevent future complications.