saudigastro.com/patients/choledochal-cyst
Category
Serious
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
The bile ducts are the thin tubes that carry bile, a digestive fluid made by the liver, from the liver to the intestine. A choledochal cyst (say "ko-led-OH-kal") is an abnormal sac-like or sausage-like widening of part of these ducts. It is usually present from birth, but it may be found in babies, children or adults. It can sit inside or outside the liver. Because it is a structural problem, it does not go away on its own and usually needs an operation.
How common is it?
Choledochal cysts are rare. They are found in both children and adults, and are reported more often in girls and women than in boys and men. Many cases are now found incidentally on scans, including prenatal ultrasound.
Why does it happen?
The exact cause is not fully known. One widely held explanation is an abnormal junction between the bile duct and the pancreatic duct, which allows pancreatic juice to flow back into the bile duct and weaken its wall. Some cysts are linked to other inborn conditions of the bile ducts or liver. It is not caused by anything a parent or patient did.
Symptoms
- Abdominal pain, often in the upper right or upper middle belly
- Yellow skin and eyes (jaundice)
- A lump that can be felt in the upper belly (more often in young children)
- Nausea and vomiting
- Pale stools and dark urine in infants with jaundice
- Repeated bouts of pancreatitis or bile duct infection
- No symptoms at all; the cyst is found on a scan done for another reason
Red flags — seek urgent medical care
Fever or chills with belly pain or jaundice
May mean infection of the bile ducts (cholangitis), which is an emergency. Go to the emergency department now.
Severe pain spreading to the back with vomiting
Could be pancreatitis (inflammation of the pancreas). Seek urgent care.
Sudden severe belly pain, a hard belly or a pale, drowsy, unwell child
A cyst can rarely rupture. A baby or child who looks seriously unwell must be seen in the emergency department immediately.
Jaundice in a newborn that lasts beyond about two weeks, with pale stools
This always needs prompt medical assessment, as bile duct problems in babies are time-sensitive.
Weight loss, persistent itching or a new lump in an adult with a known cyst
Long-standing cysts carry a raised risk of bile duct cancer, so new symptoms need prompt review.
How is it diagnosed?
Ultrasound is often the first test and may show the widened duct. An MRI scan of the bile ducts (MRCP) is the best test to show the shape and extent of the cyst and how it joins the pancreatic duct. A CT scan may add detail. Blood tests check the liver, bile ducts and pancreas. Endoscopic tests are used only in selected cases. The type of cyst (there are several types) guides surgical planning.
Outlook — what to expect
With complete surgical removal of the cyst and reconstruction of the bile duct, most people do well. Long-term follow-up with a specialist team is advised, because a small risk can remain in the remaining duct tissue, and because problems such as narrowing or stones can appear later.
Treatment
Habits & Lifestyle
There is no lifestyle measure that treats a choledochal cyst. These steps support your health while you are under specialist care.
- Attend all appointments with the surgical and liver teams
- Know the emergency signs (fever, jaundice, severe pain) and seek care immediately
- For a child: do not delay a medical review for pale stools, jaundice or repeated vomiting
- Avoid alcohol if you have had pancreatitis or have liver damage, as your doctor advises
Diet
Diet does not cause or cure the cyst. Eating well supports recovery from surgery.
- Small, regular meals are usually better tolerated if you have episodes of pain
- Reduce very fatty meals if they trigger pain or nausea
- Children should keep to a normal balanced diet for growth; ask your paediatric team about any restrictions
- After surgery, follow the hospital's instructions for restarting food and drink
Medications
Medicines do not remove a choledochal cyst. They are used to treat complications or to support surgery.
- Antibiotics treat infection of the bile ducts
- Pain relief may be given during attacks; your doctor chooses the safest option, especially for children
- Fluids through a vein may be needed when someone cannot drink
- Do not give a child any medicine or herbal remedy for belly pain or jaundice without medical advice
Procedures & Surgery
Surgery is the standard treatment for most choledochal cysts.
- Complete removal of the cyst (cyst excision) is usually advised, even if there are no symptoms
- The bile duct is then reconnected to the intestine (hepaticojejunostomy), done by a specialist surgical team
- The gallbladder is usually removed at the same operation
- Draining the cyst with a scope or tube is only a temporary measure for an infected cyst before surgery
- Regular imaging and blood tests are done afterwards to watch for narrowing, stones or other changes
Living with the condition
- Long-term follow-up is part of the plan, even if you feel completely well.
- Keep your surgical report; it helps any doctor who treats you in the future.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What type of cyst do I (or my child) have?
- When should surgery be done?
- Which team has experience with this operation?
- What follow-up will I need afterwards and for how long?
- Should other family members be checked?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide