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Choledochal Cysts

Roux-en-Y reconstruction after excision of the choledochal cyst

Gall Bladder Cancer

Green Arrow: Gall Bladder
Yellow Arrow: Bile Ducts

What is a Choledochal Cyst?

Choledochal cysts are rare cystic lesions of the biliary tree (bile ducts). The absolute cause remains elusive, although several theories have been proposed. Many believe choledochal cysts to be congenital in origin. Abnormal reflux of pancreatic secretions into the biliary ductal system is another popular idea of pathogenesis. Symptoms often differ depending on the age of the patient. Adults will commonly present with abdominal pain, related to biliary or pancreatic obstruction, while in the pediatric population jaundice is common. Surgical excision is the treatment of choice as the risk of malignancy can be as high as 20%.

What is Cancer of the Bile Ducts (also known as Cholangiocarcinoma)?

The bile from the liver and gall bladder flows down into duodenum through the bile ducts (yellow arrow). Cancer of the bile ducts is also called cholangiocarcinoma. A special type of bile duct cancer where the left and right ducts merge is known as Klatskin tumor.

Why is bile duct cancer surgery difficult?

These are technically very complicated surgeries because of the close proximity to the arterial and venous blood supply to the liver. These are often involved very early on in the disease process making the surgery technically challenging and frequently inoperable. At the Liver and Pancreas Center, Dr. Singh and his team are very experienced in complex biliary surgery and extend their expertise to providing comprehensive care for this difficult problem.

Does the Liver & Pancreas Center also treat Bile Duct injuries?

Incidental bile duct injuries caused during surgeries on the gall bladder are referred to Dr. Singh & our team from all over Southern California region. These injuries can range from simple injuries to fairly complex injuries requiring several surgeries. Due to the complexity of these surgeries for anatomical reasons explained above, these surgeries are best managed at specialized centers such as the Liver & Pancreas Center that perform these routinely.

Does the Liver & Pancreas Center also perform surgery on the gallbladder and bile ducts to remove non-cancerous, complex stones (cholecystectomy)?

Yes. Although the majority of these routine surgeries are performed by General Surgeons, our experience and expertise in operating on difficult, complex, gallbladder and bile duct cancers clearly allows our surgical team to perform standard gallstones operations (cholecystectomy) with comfort and ease.

What is Cancer of the gall bladder (GB)?

As seen in the picture, the gall bladder (green arrow) is a small sac which is located in close proximity to the liver and is principally involved in storing and concentrating bile. The commonest pathology associated with this organ is gall stones. However, occasionally it can be associated with cancer, although rare. Cancers of the GB is often picked up incidentally when the gall bladder is taken out for stones. If it is an early cancer then the removal of the gall bladder (Cholecystectomy) alone is enough. However, if the cancer is infiltrating in to the wall of the Gall Bladder, it is best served by additional aggressive surgery which often also involves removing the bed of the gall bladder on the liver, often referred to as Segment 4 or Segment 5 resection of the liver and clearance of the regional lymph nodes. Additional therapy is dictated by the final pathology report.