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.