The current management of choledochal cyst.
The diagnosis and treatment of choledochal cysts have changed dramatically in the past decade. Although history and physical exam remain paramount in arousing clinical suspicions, the classic triad of abdominal pain, jaundice, and a palpable mass is present infrequently. Ultrasonography can readily identify and precisely locate upper abdominal masses and distinguish between intrahepatic, extrahepatic, renal, and gastrointestinal cystic and solid masses. Use of the new iminodiacetic acid tracers then allows visualization of these cysts even in the presence of significant jaundice or abnormal liver function tests. For many years choledochal cystenterostomy was considered the treatment of choice because of the high morbidity and mortality originally associated with attempts at total excision. Over the years, evaluation of cystenterostomy has revealed an unacceptable rate of recurrent jaundice, ascending cholangitis, stone formation, and anastamotic stricture. In addition, a disturbing incidence of highly malignant biliary duct carcinoma that increases with the passage of time has been reported. Total excision of choledochal cysts has been reported in the English and Japanese literature with minimal morbidity and mortality and has become the treatment of choice. The authors' recent experience of two patients with this relatively rare condition confirms these changing trends and will be reported here.
D000293:Adolescent; D002648:Child; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003560:Cysts / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D011859:Radiography; D011877:Radionuclide Imaging; D014463:Ultrasonography