Choledochal Cyst: A Retrospective Study of 30 Cases From Nepal

Abstract

Introduction Choledochal cysts (CCs) are uncommon biliary lesions. Considering the evolution of imaging, we describe our experience with the presentation and management of choledochal cysts. Methods A review of the records of all patients with choledochal cyst managed in our institute were retrospectively analyzed. The study analyzed clinical presentation, diagnosis, treatment and postoperative outcomes. Results Between 2015 and 2019, 30 CCs (male/female: 7/23) were operated. We observed more adults compared to children (17 vs. 13). The median age at surgery was 18.5 years (4-67 years). The presentation included abdominal pain (90%), pancreatitis (17%0, cholangitis (13%), and incidental diagnosis in (7%). Anomalous union of the bile duct and the pancreatic duct was seen in 17%. Two patients had synchronous cholangiocarcinoma. The cysts were classified (Todani’s): I: 26; IV:3; and V: 1. The patients underwent complete excision of the cyst and Roux-en-Y hepaticojejunostomy - 27; pancreaticoduodenectomy - 1; hepaticoduodenostomy - 1; and cholecystectomy with T-tube drainage - 1 patient. The operative complications were observed in 10 (33.3%) patients: biliary leaks (four), superficial surgical site infections (four), and cholangitis (three). Only one patient developed a major complication; required re-operation for bile leak peritonitis. There was no operative mortality. One patient with cholangiocarcinoma died with the disease at three months of surgery. The remaining 29 patients are doing well at a mean follow-up of 29.5 months (12-56). Conclusion Adults CCs now far outnumber children at the time of presentation. The majority were symptomatic Todani’s type I cyst. Complete cyst excision and bilio-digestive anastomosis is the best treatment for type I and IV CCs, thus eliminating the risk of malignancy with an excellent operative outcome.

Todani Type I Common Bile Duct Cyst in an Adult Patient: Clinical Case and Literature Review

“…Se han reportado diagnósticos prenatales por ultrasonido, a una edad gestacional promedio de 20 semanas (16,17) . La triada clásica de dolor, masa en hipocondrio derecho e ictericia está presente principalmente en niños (18) , pero diversos estudios demuestran que su prevalencia es baja (18)(19)(20) . En adultos, la presentación suele ser vaga e inespecífica, y el dolor abdominal es el síntoma más común (1,20) , pero cuando los síntomas son más específicos, suelen estar relacionados con sus complicaciones (colangitis y pancreatitis) (1,8,21) .…”

Doença Cística das Vias Biliares do tipo IVa: Relato de Caso

“…A pancreatite e outros distúrbios associados podem ser manejados através de ressuscitação volêmica com solução salina, inibidores da bomba de prótons, antieméticos e analgésicos (Bhattarai;Timilsina;Khanal, 2023). Por fim, a alternativa terapêutica padrão atual para os tipos IV consiste na excisão completa do cisto juntamente com reconstrução biliodigestiva por Y de Roux, acrescidas de hepaticojejunostomia ou hepatoduodenostomia, em alguns cenários podem requerer hepatectomia parcial até transplante hepático (Pandit et al, 2020;Grover et al, 2021). No caso relatado há o planejamento de abordagem cirúrgica para provável transplante hepático.…”

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience

“…The majority of complications were wound-related, with anastomotic leaks followed by pancreatic fistula in the early phase. In the late phase, anastomotic strictures, cholangitis, adhesive intestinal obstruction, and malignancy were reported [ 10 , 12 ]. The risk of malignancy in biliary cysts exists even after the complete surgical excision, as reported in Korean and Japanese studies, but it was virtually nil in Indian studies so far, which can be attributed to the low incidence of APDBU, complete excision of cyst rather than drainage procedures, and shorter long-term follow-up [ 10 ].…”