Revision 15 for 'Todani classification of bile duct cysts'

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Todani classification of bile duct cysts

Todani classification of bile duct cysts divides choledochal cysts into 5 groups:

Type 1
  • account for 80-90% of all bile duct cysts
  • characterized by fusiform dilation of the extrahepatic bile duct
  • a subclassification has been proposed
    • Ia: dilatation of extrahepatic bile duct (entire)
    • Ib: dilatation of extrahepatic bile duct (focal segment)
    • Ic: dilatation of the common bile duct portion of extrahepatic bile duct

Theorized to form as the result of reflux of pancreatic secretions into the bile duct via anomalous pancreaticobiliary junction. Some believe them to arise from ductal plate anomalies.

See: Type I choledochal cyst

Type 2

Also known as a bile duct diverticulum.

Saccular outpouchings arising from the supraduodenal extrahepatic bile duct or the intrahepatic bile ducts.

Type 3

Also known as a choledochocele.

  • account for 5% of all bile duct cysts
  • represent protrusion of a focally dilated, intramural segment of the distal common bile duct into the duodenum.

Choledochoceles may be successfully managed with endoscopic sphincterotomy, surgical excision, or both, in symptomatic patients.

Type 4

Multiple communicating intra- and extrahepatic duct cysts.

  • second most common type of bile duct cysts (10%)
  • subdivided into subtypes A and B
    • type 4a: fusiform dilation of the entire extrahepatic bile duct with extension of dilation of the intrahepatic bile ducts
    • type 4b: multiple cystic dilations involving only the extrahepatic bile duct
Type 5

Also known as Caroli disease.

Caroli disease is a rare form of congenital biliary cystic disease manifested by cystic dilations of intrahepatic bile ducts.

Association with benign renal tubular ectasia and other forms of renal cystic disease.

Practical points

The Todani classification scheme has been called into question in the surgical literature, with claims that it may unfairly link multiple distinct processes into a spuriously coherent grading scheme 2,3.

See also

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