title: Choledochal cysts: age of presentation, symptoms, and late complications related to Todani's classification.
abstract: OBJECTIVE
  The aim of this study was to compare presentation, complications, diagnosis, and treatment of choledochal cysts in pediatric and adult patients.
  
  
  METHODS
  Forty-two patients were analyzed after subdivision into 3 groups: group A, less than 2 years (n = 10); group B, 2 to 16 years (n = 11); group C, greater than 16 years (n = 21).
  
  
  RESULTS
  The cysts were classified as extrahepatic (n = 33), intrahepatic (n = 5), and combined (n = 4). Seventy-six percent of patients presented with abdominal pain, (20 of 21 group C), and 57% with jaundice, (10 of 10 group A). Cholangiocarcinoma occurred in 6 patients, 4 of whom had previously undergone internal drainage procedures. Excision of the extrahepatic cyst was performed in 27 of 37 patients. Five patients, of whom, 4 had cholangiocarcinoma, were beyond curative treatment at the time of diagnosis. Six patients had died at the closure of this study, 5 of them had carcinoma.
  
  
  CONCLUSIONS
  Presenting symptoms are age dependent with jaundice prevailing in children and abdominal pain in adults. In view of the high risk of cholangiocarcinoma, early resection and not internal drainage is the appropriate treatment of extrahepatic cysts. Patients who had undergone internal drainage in the past still should undergo resection of the cyst.
authors.affiliation: Department of Surgery, Academic Medical Center and Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors.forename: J S
authors.initials: JS
authors.lastname: de Vries
authors.forename: S
authors.initials: S
authors.lastname: de Vries
authors.forename: D C
authors.initials: DC
authors.lastname: Aronson
authors.forename: D K
authors.initials: DK
authors.lastname: Bosman
authors.forename: E A J
authors.initials: EA
authors.lastname: Rauws
authors.forename: A
authors.initials: A
authors.lastname: Bosma
authors.forename: H A
authors.initials: HA
authors.lastname: Heij
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D001650:Bile Duct Neoplasms / Q000453:epidemiology; D001653:Bile Ducts, Intrahepatic; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018281:Cholangiocarcinoma / Q000453:epidemiology; D015529:Choledochal Cyst / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007565:Jaundice / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution; D015996:Survival Rate