title: Choledochoceles: are they choledochal cysts?
abstract: OBJECTIVE
  The aim of this analysis was to report a multidisciplinary series comparing choledochoceles to Todani Types I, II, IV, and V choledochal cysts.
  
  
  BACKGROUND
  Choledochoceles have been classified as Todani Type III choledochal cysts. However, most surgical series of choledochal cysts have reported few choledochoceles because they are managed primarily by endoscopists.
  
  
  METHODS
  Surgical, endoscopic, and radiologic records were reviewed at the Riley Children's Hospital and the Indiana University Hospitals to identify patients with choledochal cysts. Patient demographics, presenting symptoms, radiologic studies, associated abnormalities, surgical and endoscopic procedures as well as outcomes were reviewed.
  
  
  RESULTS
  A total of 146 patients with "choledochal cysts" including 45 children (31%) and 28 with choledochoceles (18%) were identified, which represents the largest Western series. Patients with choledochoceles were older (50.7 vs. 29.0 years, P < 0.05) and more likely to be male (43% vs. 19%, P < 0.05), to present with pancreatitis (48% vs. 24%, P < 0.05) rather than jaundice (11% vs. 30%, P < 0.05) or cholangitis (0% vs. 21%, P < 0.05), to have pancreas divisum (38% vs. 10%, P < 0.01), and to be managed with endoscopic therapy (79% vs. 17%, P < 0.01). Two patients with choledochoceles (7%) had pancreatic neoplasms.
  
  
  CONCLUSIONS
  Patients with choledochoceles differ from patients with choledochal cysts with respect to age, gender, presentation, pancreatic ductal anatomy, and their management. The association between choledochoceles and pancreas divisum is a new observation. Therefore, we conclude that classifications of choledochal cysts should not include choledochoceles.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Ziegler
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Aakash
authors.initials: A
authors.lastname: Chauhan
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Dana
authors.initials: D
authors.lastname: Moffatt
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.forename: Karen W
authors.initials: KW
authors.lastname: West
authors.forename: Jay L
authors.initials: JL
authors.lastname: Grosfeld
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000150:complications; D015529:Choledochal Cyst / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities; D010190:Pancreatic Neoplasms / Q000150:complications; D010195:Pancreatitis / Q000150:complications; D012737:Sex Factors