Which one of the following statements regarding choledochal cyst is not correct?
Majority of patients are diagnosed after 10 years of age.
The incorrect statement, and hence the answer, is that most patients are diagnosed after 10 years of age. In fact most choledochal cysts present in infancy and childhood, about 60-80 percent before 10 years, and many are now detected antenatally. The classical triad of pain, jaundice and a right hypochondrial mass is complete in fewer than 20 percent; infants present with obstructive jaundice mimicking biliary atresia, older patients with pain, cholangitis or pancreatitis. There is female preponderance (3-4 : 1) and a higher incidence in East Asians.
The other options are true. Choledochal cysts are congenital dilatations of the intra- and/or extra-hepatic biliary tree, classified by Todani into five types, type I (fusiform CBD dilatation) being commonest at 80-90 percent and type V being Caroli disease; the favoured cause is an anomalous pancreaticobiliary junction with a long common channel. Cholangiocarcinoma risk is about 10-30 percent lifetime, which is exactly why complete excision with Roux-en-Y hepaticojejunostomy is the treatment of choice, internal drainage being obsolete.
Key point: Choledochal cyst is a disease of childhood, usually Todani type I, and must be excised, never merely drained.
Important Questions from Hepatobiliary & Pancreatic Surgery
Which among the following are complications of liver trauma?
1. Liver abscess
2. Biliary fistula
3. Portal thrombosis
4. Liver failure
Select the correct answer using the code given below.
Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
2. Diabetes mellitus
3. Caucasian ethnicity
4. Male gender
Select the correct answer using the code given below.
Which of the following are options for management of a pancreatic pseu- docyst?
1. Pancreaticoduodenectomy
2. Cystogastrostomy
3. Percutaneous drainage
4. Endoscopic drainage
Select the correct answer using the code given below :
- Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging Select the correct answer using the code given below :
