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.
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2. Inferior surface of the right lobe of the liver forms the superior boundary of Calot's triangle
3. Right hepatic artery is usually found as a content of the Calot's triangle
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