title: Management of choledochal cysts and their complications.
abstract: Choledochal cysts are increasingly reported in adults. The presence of cyst-related complications alters its presentation and complicates the management. We reviewed our experience to find the clinical presentation, complications, and the management of choledochal cysts. The records  of 132 patients with choledochal cysts presented to us between 2003 and 2010 maintained as a prospective database were analyzed for demography, clinical presentation, radiological investigation, management, and outcome. There were 12 children and 120 adults. Based on preoperative cholangiogram,  93 (71%) patients had Type I and 39 (29%) Type IVA cysts. The overall incidence of complicated choledochal cyst was 4 of 12 (33%) in children and 85 of 120 (71%) in adults. The most common complication was cystolithiasis (49%) followed by cholangitis (32%), acute pancreatitis (10%), hepatolithiasis  (7%), malignancy (3%), portal hypertension (2%), and chronic pancreatitis (2%). Acute pancreatitis and cholangitis were managed conservatively. Endoscopic stenting was performed in patients with cholangitis and those requiring staged treatment as a result of portal hypertension. Overall 114  patients underwent cyst excision with Roux-en-y hepaticojejunostomy. The overall morbidity was 17.5 per cent (wound infection 13% and bilioenteric anastomotic leak 7%). There was one postoperative death resulting from cardiac failure. Three patients developed anastomotic stricture and underwent  redo hepaticojejunostomy. Choledochal cysts in adults are often associated with complications. Complications are more common in adults compared with children. Acute pancreatitis, cholangitis and portal hypertension are managed conservatively and then followed up by definitive surgery. Cyst  excision with Roux-en-Y hepaticojejunostomy is necessary to prevent the recurrence of complications.
authors.affiliation: Department of Gastrointestinal Surgery, GB Pant Hospital, New Delhi, India. sundeepsaluja@yahoo.co.in
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nayeem
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.forename: Giriraj
authors.initials: G
authors.lastname: Bora
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
mesh_terms: D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D001662:Biliary Tract Surgical Procedures / Q000706:statistics & numerical data*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000453:epidemiology; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D004066:Digestive System Diseases / Q000453:epidemiology*; D005706:Gallbladder Neoplasms / Q000453:epidemiology; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D020347:Lithiasis / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D001744:Urinary Bladder Calculi / Q000453:epidemiology; D055815:Young Adult