title: Diagnosis and management of giant choledochal cysts: complexities compared to smaller cysts.
abstract: BACKGROUND
  This study presents our 11-year surgical experience with choledochal cysts (CDC), focusing on the complexity in the diagnosis and management of large-size CDCs.
  
  
  METHODS
  Medical records of 70 patients who underwent surgery for CDC between 2000 and 2011 were retrospectively reviewed. Of them, ten patients were found with cyst size >10 cm (group A), and we compared the differences in the clinical presentation, radiological diagnosis and surgical management with those with cysts ≤10 cm in size (group B).
  
  
  RESULTS
  Abdominal pain and lump were noted in all group A patients, but only 67 % and 14 % in group B patients, respectively. Sixty percent of group A, but only 14 % of group B patients, had a triad of abdominal pain, mass and jaundice. Cholangitis was more common in group A patients. Most of group B patients were correctly diagnosed with ultrasound alone, but misdiagnosis occurred more frequently in group A. Magnetic resonance cholangiopancreatography correctly achieved the diagnosis in all. Operative time (5 vs. 3 h) and blood loss (300-500 vs. 50-100 mL) were more in group A in comparison to group B.
  
  
  CONCLUSIONS
  The clinical presentation and surgical management of giant choledochal cysts differ from their smaller counterparts. Diagnostic dilemma was common with giant CDC especially with ultrasound and CT.
authors.affiliation: Department of Gastrointestinal Surgery, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna 800 020, India. utpalanand2@gmail.com
authors.forename: Utpal
authors.initials: U
authors.lastname: Anand
authors.forename: Rajeev Nayan
authors.initials: RN
authors.lastname: Priyadarshi
authors.forename: Bindey
authors.initials: B
authors.lastname: Kumar
authors.forename: Chiranjeev
authors.initials: C
authors.lastname: Khandelwal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods*; D015529:Choledochal Cyst / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult