Choledochoceles: are they choledochal cysts?
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.
Ziegler
Kathryn M
KM
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Pitt
Henry A
HA
Zyromski
Nicholas J
NJ
Chauhan
Aakash
A
Sherman
Stuart
S
Moffatt
Dana
D
Lehman
Glen A
GA
Lillemoe
Keith D
KD
Rescorla
Frederick J
FJ
West
Karen W
KW
Grosfeld
Jay L
JL
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