Todani classification of choledochal cysts guides surgical management. A Type I choledochal cyst in a child is best managed by:

• A Cyst excision with Roux-en-Y hepaticojejunostomy ✓
• B Endoscopic cyst drainage via ERCP and sphincterotomy
• C Cystduodenostomy to establish internal drainage
• D Observation with annual ultrasound if asymptomatic

Explanation

Todani Type I (fusiform or saccular dilatation of the common bile duct, the most common type) is treated by complete cyst excision with Roux-en-Y hepaticojejunostomy to prevent malignant transformation, which occurs in 10-15% if untreated (risk increases with age). Internal drainage procedures such as cystduodenostomy or cystenterostomy are contraindicated because they leave the cyst wall in situ and do not eliminate malignancy risk. Pancreatic-biliary maljunction (common channel anomaly) is associated and produces reflux of pancreatic juice into the biliary system.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.