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Have Had Surgery For Choledocal Cyst. Started Jaundice, Fever And Vomiting. What Treatment Should Be Done?
Question: Hello Sir, My name is XXXXXX, my age is 25. I had choledocal cyst which was removed in my last open surgery on May 2008, Microscopic report of the cyst “cyst wall shows chronic non specific inflammation “. After 2 years I face again problems like jaundice, fever, vomiting etc, but no problem between these 2 years. When I asked doctor about this he suggest for MRCP scan to find out the exact problem and found stricter is there and ask to admit for reoperation to make the bile flow normal. Operation was held on Dec2010, till today I have no problem. Below is my current LFT report as on Feb 2012: Total Bilurubin 2.08 Direct 1.48 Indirect .60 AST 22 ALT 18 Alkaline phosphatise 157 What I would like to know, 1. How many days I could live without gallbladder (as I know Gallbladder and CBD was removed in my 1st operation) and what are the complications in future? 2. As I am single, if I would like to marry, Could I enjoy a happy married life if yes Could I be pregnant and born a healthy baby? 3. Over time problems would be more as compare to present. 4. Any food restrictions ? Doctors please please be honest with your answers. As a brave girl I face any truth you have…
Hello,
Thanks for posting your query .
I understand your concern as a vigilant health conscious individual and appreciate your efforts and courage to face your health problems .
Please do not worry at all .The prognosis after excision of a choledochal cyst is usually excellent however long term risk of gallstones and cholangiocarcinoma make it necessary to maintain a life long regular follow up with your doctor.
I will try to give straightforward answers to your questions one by one.
Answer1. The main complication which one can develop is cholangiocarcinoma ( 8-19% risk )or gallstones and cholangitis due to stricture , however since you have undergone complete cyst excision and even revision surgery for stricture you are less likely to get these complications in future.So your life expectancy won't be affected and unless there is development of cancer ( cholangiocarcinoma ) you can lead a near normal life ahead.
Answer 2. Yes you can get married and conceive a healthy child if you have no hormonal or uterine problems. The undergone surgery won't affect your fertility.
Answer 3. No , unless you develop any cancer or further bile stasis etc you are not likely to increase your problems with time . Just make sure to undergo regular health check ups with your doctor.
Answer4. Food restrictions Are as follows,
Avoid HIGH-FAT AND FRIED FOODS, Caffeine, found in coffee, tea, soft drinks and chocolate, also whole milk ( use low fat or skimmed milk).
Vegetables like broccoli, cauliflower and cabbage can cause excess abdominal gas and also aggravate your digestive system after gallbladder removal. The same goes for beans and legumes or any food that previously caused you gas and accompanying stomach upset.
Hope I have answered your queries.
Wishing you good health.
Kindly accept my answer if you have no further queries.
Regards
Thanks for posting your query .
I understand your concern as a vigilant health conscious individual and appreciate your efforts and courage to face your health problems .
Please do not worry at all .The prognosis after excision of a choledochal cyst is usually excellent however long term risk of gallstones and cholangiocarcinoma make it necessary to maintain a life long regular follow up with your doctor.
I will try to give straightforward answers to your questions one by one.
Answer1. The main complication which one can develop is cholangiocarcinoma ( 8-19% risk )or gallstones and cholangitis due to stricture , however since you have undergone complete cyst excision and even revision surgery for stricture you are less likely to get these complications in future.So your life expectancy won't be affected and unless there is development of cancer ( cholangiocarcinoma ) you can lead a near normal life ahead.
Answer 2. Yes you can get married and conceive a healthy child if you have no hormonal or uterine problems. The undergone surgery won't affect your fertility.
Answer 3. No , unless you develop any cancer or further bile stasis etc you are not likely to increase your problems with time . Just make sure to undergo regular health check ups with your doctor.
Answer4. Food restrictions Are as follows,
Avoid HIGH-FAT AND FRIED FOODS, Caffeine, found in coffee, tea, soft drinks and chocolate, also whole milk ( use low fat or skimmed milk).
Vegetables like broccoli, cauliflower and cabbage can cause excess abdominal gas and also aggravate your digestive system after gallbladder removal. The same goes for beans and legumes or any food that previously caused you gas and accompanying stomach upset.
Hope I have answered your queries.
Wishing you good health.
Kindly accept my answer if you have no further queries.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Thank you so much for your quick and clear reply.
Still my Total Bilirubin is 2.08 which is not normal range. Why ? Is there any stricture or the hapatatic cyst on left lobe of my liver blocks bile flow.
In my 2nd MRCP scan my doctor found another small hepatatic cyst in left lobe of the liver. Doctors said no problem and we will observe it then we decide ...What to do with that cyst.
How to remove that hepatatic cyst ?
Is it possible to remove that cyst through laparoscopic surgery...
Is it possible to dissolve that cyst through medicine?
Is there any method to dissolve that cyst with out surgery(Suggest Abroad also).
Is that Cyst create problem in future or it may convert to cancer in future?
Is there possibilities of stricture in future ?
Thanks
XXXXXX
Thank you so much for your quick and clear reply.
Still my Total Bilirubin is 2.08 which is not normal range. Why ? Is there any stricture or the hapatatic cyst on left lobe of my liver blocks bile flow.
In my 2nd MRCP scan my doctor found another small hepatatic cyst in left lobe of the liver. Doctors said no problem and we will observe it then we decide ...What to do with that cyst.
How to remove that hepatatic cyst ?
Is it possible to remove that cyst through laparoscopic surgery...
Is it possible to dissolve that cyst through medicine?
Is there any method to dissolve that cyst with out surgery(Suggest Abroad also).
Is that Cyst create problem in future or it may convert to cancer in future?
Is there possibilities of stricture in future ?
Thanks
XXXXXX
Hello,
Thanks for the follow up.
In your case your total bilirubin levels are almost near normal though different laboratories have different ranges varying from 0.2 to 1.9 mg/dl.
If you have an intrahepatic cyst it could be the reason for some persistent bile stasis .
However after a surgical excision 83% of such cysts resolve on their own without surgery or medicines . Though they are not likely to cause cancer they can cause hepatitis and biliary stones in future . But your doctor has rightly advised to wait and watch as I said the main treatment for them is removal of the choledochal cyst and a enterostomy which relieves the bile stasis which you have already undergone .
It is very likely that this dilated cyst may resolve with time or will not worsen to cause any problems .
If it does in future ,then unfortunately an open or laparoscopic surgery ( depending on individual case might be required for the same . There are no medications to dissolve it as it is a normal integral part of your liver which is just abnormally dilated due to the biliary pressure.
The recurrence of stricture post surgery cannot be predicted as it depends on the surgical procedure , the anatomical constitution of the patient and development of any peri operative complications . So one cannot assure you that you will not have strictures however the best person to predict it is your operative surgeon who can give you a fair idea of the same.
Hope I have answered your queries.
Kindly accept my answer in case you have no further queries.
Regards
Thanks for the follow up.
In your case your total bilirubin levels are almost near normal though different laboratories have different ranges varying from 0.2 to 1.9 mg/dl.
If you have an intrahepatic cyst it could be the reason for some persistent bile stasis .
However after a surgical excision 83% of such cysts resolve on their own without surgery or medicines . Though they are not likely to cause cancer they can cause hepatitis and biliary stones in future . But your doctor has rightly advised to wait and watch as I said the main treatment for them is removal of the choledochal cyst and a enterostomy which relieves the bile stasis which you have already undergone .
It is very likely that this dilated cyst may resolve with time or will not worsen to cause any problems .
If it does in future ,then unfortunately an open or laparoscopic surgery ( depending on individual case might be required for the same . There are no medications to dissolve it as it is a normal integral part of your liver which is just abnormally dilated due to the biliary pressure.
The recurrence of stricture post surgery cannot be predicted as it depends on the surgical procedure , the anatomical constitution of the patient and development of any peri operative complications . So one cannot assure you that you will not have strictures however the best person to predict it is your operative surgeon who can give you a fair idea of the same.
Hope I have answered your queries.
Kindly accept my answer in case you have no further queries.
Regards
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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