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    Komi Classification of Bile Duct Cysts

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    mero1983
    Komi classification divides anomalous union of the pancreatico-bile ducts into 3 types based on the angle of union and presence or absence of dilatation of the common channel. Todani classification divides choledochal cysts into 5 types. Type I involves fusiform dilation of the extrahepatic bile duct. Type II is a bile duct diverticulum. Type III is a choledochocele, protrusion of the distal common bile duct into the duodenum. Type IV involves multiple communicating intra- and extrahepatic duct cysts. Type V is Caroli disease, cystic dilations of intrahepatic bile ducts associated with renal abnormalities.

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    Komi Classification of Bile Duct Cysts

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    mero1983
    240 views3 pages
    Komi classification divides anomalous union of the pancreatico-bile ducts into 3 types based on the angle of union and presence or absence of dilatation of the common channel. Todani classification divides choledochal cysts into 5 types. Type I involves fusiform dilation of the extrahepatic bile duct. Type II is a bile duct diverticulum. Type III is a choledochocele, protrusion of the distal common bile duct into the duodenum. Type IV involves multiple communicating intra- and extrahepatic duct cysts. Type V is Caroli disease, cystic dilations of intrahepatic bile ducts associated with renal abnormalities.

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    Komi classification of bile duct cysts

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    Komi classification divides anomalous union of the pancreatico-bile ducts into 3 types based on the angle of union and presence or absence of dilatation of the common channel. Todani classification divides choledochal cysts into 5 types. Type I involves fusiform dilation of the extrahepatic bile duct. Type II is a bile duct diverticulum. Type III is a choledochocele, protrusion of the distal common bile duct into the duodenum. Type IV involves multiple communicating intra- and extrahepatic duct cysts. Type V is Caroli disease, cystic dilations of intrahepatic bile ducts associated with renal abnormalities.

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    240 views3 pages

    Komi Classification of Bile Duct Cysts

    Uploaded by

    mero1983
    Komi classification divides anomalous union of the pancreatico-bile ducts into 3 types based on the angle of union and presence or absence of dilatation of the common channel. Todani classification divides choledochal cysts into 5 types. Type I involves fusiform dilation of the extrahepatic bile duct. Type II is a bile duct diverticulum. Type III is a choledochocele, protrusion of the distal common bile duct into the duodenum. Type IV involves multiple communicating intra- and extrahepatic duct cysts. Type V is Caroli disease, cystic dilations of intrahepatic bile ducts associated with renal abnormalities.

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    Komi classification of bile duct cysts

    Komi classification of bile duct cysts , as stated by Komi et al , divides anomalous union of the
    pancreatico-bile ducts (AUPBD) into 3 types based on the angle of union of the ducts 1.
    Type I

    union of the ducts at a right angle to each other


    o IA without dilatation or
    o IB with dilatation of the common channel.

    Type II

    unions of the ducts with an acute angle between them


    o IIA without dilatation (IIA) or
    o IIB with dilatation of the common channel.

    Type III

    comprises of a complex patterns of accessory pancreatic ducts, with or without intricate duct networks.
    o IIIA - is similar to the classic pancreas divisum with biliary dilatation.
    o IIIB - is characterised by the absence of the Wirsungs duct.
    o IIIC1 - tiny communication exists between the main duct and the accessory ducts.
    o IIIC2 - comprises of a common channel made up of common and accessory ducts of equal caliber.
    o IIIC3 - total or partial dilatation of the ductal system.

    Todani classification of bile duct cysts

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

    See: type I choledochal cyst

    account for 80-90% of all bile duct cysts

    characterized by fusiform dilation of the extrahepatic bile duct

    a subclassification has been proposed


    o

    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.
    Type II

    Also known as a bile duct diverticulum.

    account for 3% of all bile duct cysts

    represent a true diverticulum

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

    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 IV

    Multiple communicating intra- and extrahepatic duct cysts.

    second most common type of bile duct cysts (10%)

    subdivided into subtypes A and B


    o

    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 V

    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.

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