Management of accessory hepatic ducts in choledochal cysts

This report describes the surgical management of 2 children with fusiform c holedochal cysts who had accessory hepatic ducts (AHD) identified during ex cisional surgery for fusiform choledochal cysts (CC). Two children presenti ng with a triad of recurrent jaundice, fever, and abdominal pain were inves tigated and found to have type 1 choledochal cyst. Preoperative imaging and intraoperative cholangiography missed the AHD in both cases. In one of the patients, the main and the accessory ducts were separated by the right hep atic artery. In both the patients the accessory ducts were reconstructed su ccessfully into a Roux loop along with the main common hepatic duct. Follow -up studies showed no evidence of biliary tract obstruction or atrophic cha nges in the liver. There was satisfactory uptake and drainage on hepatic sc intigraphy. During excision of CC, AHD may be encountered. These may be mis sed on preoperative imaging. AHD may have a close relationship with neighbo ring vascular structures in the porta. Accessory hepatic ducts should be an ticipated, identified, and reimplanted into the Roux loop during excisional surgery. Copyright (C) 2001 by W.B. Saunders Company.