Bile Duct Cysts

Bile duct illustratiion
Bile Duct Cysts
By Dr. Lee Ser Yee
Choledochal cysts are rare congenital dilations (enlargements) of the bile ducts, a network of long tube-like structures that carry bile from the liver to the small intestine to aid in digestion.

It may involve the bile ducts inside, outside the liver, or both. Choledochal cysts occur more often in children, women and are more common in the Asian population.

Choledochal cyst is considered a potentially pre-cancerous condition, this risk of cancer provides the basis for the current treatment strategies.

Cancer may develop in up to 20-30% of patients with choledochal cyst over time. Choledochal cysts are classified according to their location and extent of involvement configurations.

Bile duct anatomy illustration

Risk factors and Prevention

The exact cause is not known. It is a developmental abnormality of the bile duct which may be associated with other congenital anomalies. There is no known prevention but early diagnosis and treatment confers better outcomes.

Symptoms
  • Some patients have no symptoms – these may be detected when scans are done for health screening or other conditions
  • Obstructive jaundice - yellowing of the skin and eyes, itch, tea-coloured urine & pale stools
  • Upper abdominal pain and discomfort- due to the cyst, an enlarged liver or associated pancreatitis (inflammation of the pancreas)
  • Fever, chills & rigors- due to cholangitis (bacterial infection of the bile duct)
  • Unexplained loss of weight and appetite
Diagnosis

The diagnosis of choledochal cyst is usually through imaging such as ultrasound. Other imaging tests such as CT, MRI/MRCP or ERCP may be necessary to further delineate the extent of the disease and guide surgical management.

Treatment

Surgery is the best way to treat choledochal cyst. This involves surgical removal of the diseased bile duct with the cyst and reconstructing the bile duct by joining the remnant bile duct to the small intestine so as to re-establish the continuity of the digestive system.

If suitable, this can be approached via a minimally invasive “keyhole” techniques (laparoscopic, robotic) to minimise pain, scars, shorten hospital stay while optimizing recovery.

For more information, please consult our Hepato-Pancreato-Biliary (HPB) specialist.

liver cancer surgeon - Dr Lee Ser Yee
Dr Lee Ser Yee

Senior Consultant Hepatopancreatobiliary Surgeon

MBBS, MMed (Surgery), MSc, FAMS, FRCSEd

Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the Department of Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He served as the Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program and the SingHealth Surgical Skills Centre.

He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.

He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.

liver cancer surgeon - Dr Lee Ser Yee
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