Breast Lumps – Is it nightmare for woman?

Breast Lumps – Is it nightmare for woman?

Background 

Biliary cysts commonly known as choledochol cysts are commonly seen in Asian population. Cyst is abnormal thinning of the wall of the common bile duct which lead to enlargement of the bile duct in various locations and patterns. Common bile duct is is channel formed by the bile ducts arising from the liver to drain the bile and pancreatic juices in to the small intestines which is at most  essential for the digestion. This disease usually affects the young and middle aged individuals. 

Common cause of Choledochol cyst 

There are no specific cause for this disease. There is scientific theory which says there abnormality in the joining of common bile duct coming from and the duct arising from the pancreas. This leads to abnormal reflux of pancreatic juices in to the common bile duct which normally should drain in to the intestine. The very nature of pancreatic juices affects the common bile duct leading to weakness of the wall of the duct causing abnormal enlargement. According to the different areas of cysts development they are divided in to five different categories. 

Symptoms of choledochol cysts

  1. Pain in the right upper quadrant 
  2. Palpable lump in upper abdomen
  3. Yellowish discolouration of eyes, soles and palms
  4. Itching over the body 
  5. Nausea and vomiting 
  6. Episodes of recurrent infection( cholangitis and pancreatitis) 
  7. Weight loss and decrease appetite 
  8. Cirrhosis of the liver and liver failure
  9. Increased risk of bile duct cancers 

Diagnosis and investigations 

Once you notice these symptoms it is advisable to visit you clinician without delay. Clinician will examine you and advice investigations accordingly 

  1. Routine Blood investigations including liver and kidney profile
  2. Ultrasonography of the abdomen 
  3. Magnetic resonance imaging( MRI) is investigation of choice in these cases to confirm the diagnosis and understand the extent of the cyst. This will help in planning the surgical treatment. 
  4. Endoscopic retrograde cholangiopancreatography (ERCP) is useful to relive high grade jaundice and infection before surgery. 

Treatment 

The treatment of choice for the cysts is always surgery. Once the diagnosis and type of cyst is confirmed the extent of surgery will be decided. Usually complete excision of the cysts is always the goal of the surgery as remanent disease can be risk of cancer. The surgery can be performed by conventional open surgery method as well as laparoscopic surgery. 

The surgery (Choledochol cyst excision) involves complete removal of the affected bile duct along with gallbladder and joining of the small intestine to the remaining bile duct in the liver Hepatico-jejunostomy). Type 5 disease is usually present in paediatric age group will require either liver resection or liver transplantation depending upon the extent of disease 

Recovery after the surgery is generally rapid and the patients usually require hospital stay of 3-5 days. There is no stringent follow up required for this patients if the biopsy of removed tissue is negative for cancer. Though we advice yearly check up with ultrasonography to determine any recurrence or development of cancer. 

To consult with best team of general, minimal access and liver surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

To consult with best team of general, minimal access and liver surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

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