title: Clinical comparison of choledochal cysts between children and adults.
abstract: OBJECTIVE
  Choledochal cyst of the bile duct is characterized by cystic dilatation of the intra- or extrahepatic bile ducts. It is a relatively uncommon disease and there is still much controversy regarding its etiology as being congenital or acquired.
  
  
  METHODS
  The medical records of 60 patients who underwent surgical treatments for choledochal cyst between April 1995 and April 2009 at the Gachon University Gil Hospital were reviewed retrospectively. To compare the clinical characteristics, patients under 19 years of age were grouped into children and the others were grouped into adults.
  
  
  RESULTS
  Of the overall 60 patients, 24 were grouped into children and 36 were grouped into adults. Female predominance was common in both groups (M : F=1 : 6.5). The most common clinical symptom was abdominal pain (73.3%) in both groups. Children had remarkable jaundice (33.3% vs. 0%) and gastrointestinal symptoms including nausea and vomiting. Fever and chills were more common in children because of the associated complications of cholangitis. According to the Todani classification, type I was the most common form of choledochal cyst in both groups, and type IVa was significantly more common in children than adults (45.3% vs. 16.7%). Thirty patients (50%) had anomalous pancreaticobiliary ductal union which was confirmed by preoperative imaging studies or intraoperative cholangiography. All patients except for one child underwent cyst excision with hepaticojejunostomy.
  
  
  CONCLUSIONS
  There was no significant difference in the clinical characteristics of choledochal cysts between children and adults. However, combined diseases especially bile duct malignancy were common in aged patients, early detection and more aggressive surgery is necessary for patients with choledochal cysts.
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Jang
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Kun Kuk
authors.initials: KK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Jung Nam
authors.initials: JN
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Yang Seo
authors.initials: YS
authors.lastname: Koo
authors.affiliation: Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Yeon Suk
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeon Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.
authors.forename: Yeon Ho
authors.initials: YH
authors.lastname: Park
keywords: Adults; Children; Choledochal cyst; Malignancy