Which statement regarding choledochal cysts in children is correct?
- A Internal drainage into the duodenum is the preferred definitive operation
- B Todani type I fusiform dilatation of the common bile duct is the most common variety ✓
- C They present almost exclusively in adult life as cholangitis
- D Malignant change occurs only in patients who have undergone previous surgery
Correct answer: B. Todani type I fusiform dilatation of the common bile duct is the most common variety
Explanation
Todani classification divides choledochal cysts into five types, and type I fusiform dilatation of the extrahepatic bile duct accounts for the great majority. Definitive treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy, because retained cyst mucosa carries a high risk of cholangiocarcinoma even after simple internal drainage, which makes option A wrong. Many present in childhood with the classical triad of pain, mass and jaundice, though all three elements occur together in only a minority.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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