Choledochal cyst in the adult.
OBJECTIVE
The authors examined the natural history of choledochal cysts in adults treated surgically.


BACKGROUND
An initial diagnosis of choledochal cyst is uncommon in adults. The recommended treatment is excision, rather than bypass, to achieve effective biliary drainage and because of the risk of cancer.


METHODS
A retrospective study of 27 adult patients was completed to determine the frequency of anastomotic complications and the incidence of cancer.


RESULTS
Fifteen patients were treated by cyst excision, and one developed an anastomotic stricture, treated by percutaneous dilation. Eight of 11 patients treated by cyst enterostomy required additional surgery for anastomotic revision. A final patient was treated by T-tube drainage. Five of the seven patients with cancer have died at a mean of 21.6 months.


CONCLUSIONS
This experience documents the high incidence of cancer (26%), and high rate of stricture after cyst enterostomy (73%). The dismal prognosis once cancer has developed warrants cyst excision, even in asymptomatic patients, including those with prior cyst enterostomies.
Stain
S C
SC
Department of Surgery, University of Southern California, School of Medicine, Los Angeles, USA.
Guthrie
C R
CR
Yellin
A E
AE
Donovan
A J
AJ
D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology; D002648:Child; D015529:Choledochal Cyst / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000209:etiology; D003138:Common Bile Duct Neoplasms / Q000209:etiology / Q000473:pathology; D003251:Constriction, Pathologic / Q000209:etiology; D004322:Drainage; D004385:Duodenostomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects; D012189:Retrospective Studies