title: Choledochal cysts in children: Intrahepatic ductal dilatation does not indicate true intrahepatic biliary duct disease.
abstract: OBJECTIVE
  Choledochal cysts (CCs) are rare abnormalities of the biliary tract. Presenting our clinical experience with CCs herein, we aimed to identify if intrahepatic ductal dilatation indicates true intrahepatic biliary duct disease.
  
  
  METHODS
  We retrospectively reviewed all cases of CCs in children diagnosed at a single center (Başkent University Fac-ulty of Medicine, Department of Pediatric Surgery) institution from 2005 to 2015.
  
  
  RESULTS
  Of 18 patients with CCs, 7 were males (39%). The age range was 3 months to 17 years (mean age, 6.2±3.8 years). Intrahepatic bile duct dilatation was detected in 13 (72%) patients by preoperative scanning. Type I, II, III, and IVA cysts were diagnosed in 13, 1, 1, and 3 patients, respectively. In all patients, total cyst excision and Roux-en-Y hepaticoenterostomy were performed.
  
  
  CONCLUSIONS
  In this study, most intrahepatic ductal dilatations seen on preoperative imaging were thought to be caused by a distal obstruction, not true intrahepatic biliary duct disease. This study supports the hypothesis that preoperatively distinguishing between type I and type IVA CCs is not necessary; it does not affect the initial treatment. We consider that complete cyst excision with Roux-en-Y hepaticojejunostomy is safe and should be performed soon after diagnosis, irrespective of symptom severity to avoid future complications.
authors.affiliation: Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey. hozkangezer@yahoo.com.tr.
authors.forename: Hasan Özkan
authors.initials: HÖ
authors.lastname: Gezer
authors.forename: Pelin
authors.initials: P
authors.lastname: Oğuzkurt
authors.forename: Abdulkerim
authors.initials: A
authors.lastname: Temiz
authors.forename: Emine
authors.initials: E
authors.lastname: İnce
authors.forename: Semire Serin
authors.initials: SS
authors.lastname: Ezer
authors.forename: Akgün
authors.initials: A
authors.lastname: Hiçsönmez
mesh_terms: D000293:Adolescent; D000713:Anastomosis, Roux-en-Y; D001649:Bile Duct Diseases / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000473:pathology* / Q000601:surgery; D004108:Dilatation, Pathologic; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods; D008099:Liver / Q000601:surgery; D008297:Male; D012189:Retrospective Studies