Choledochal cyst: varied clinical presentations and long-term results of surgery.
The clinical features and long-term outcome of 21 children with choledochal cyst treated over a 31-year-period is reviewed. All 7 infants ( < 1-year-old) presented with jaundice. Only 3 older children (14%) presented with the classical triad of pain, jaundice and an abdominal mass. Other forms of presentation included pancreatitis (n = 8), cholangitis (n = 3), biliary peritonitis (n = 2) and biliary cirrhosis (n = 2). An incidental diagnosis of a choledochal cyst was made in 3 patients one each with bilateral ureteroceles, renal hypoplasia and meningitis with hepatitis A infection. An elevated serum amylase (SA: mean = 1005 U/L) and intraoperative bile amylase (BA: mean = 16,902 U/L) was observed in all 8 children with pancreatitis. Complete excision of the choledochal cyst with Roux-en-Y hepaticojejunostomy was the primary operative procedure in 18 patients. The remaining patients underwent cystoduodenostomy (n = 2) and cystojejunostomy (n = 1). Recurrent cholangitis and stricture formation complicated cyst enterostomies. In comparison cyst excision with Roux-en-Y hepaticojejunostomy gave excellent long-term results with minimal complication.
Samuel
M
M
Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
Spitz
L
L
D015746:Abdominal Pain / Q000209:etiology; D000713:Anastomosis, Roux-en-Y; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000209:etiology; D015529:Choledochal Cyst / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D002779:Cholestasis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D008297:Male; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome