Choledochal Cyst Disease A Changing Pattern of Presentation

Abstract

ObjectiveThe authors compared the presentation, treatment, and long-term outcome of children and adults with choledochal cysts. Summary Background DataThe typical patient with choledochal cyst disease has been the female infant with the triad of jaundice, an abdominal mass, and pain. However, the recent experience of the authors suggested that the disease currently is recognized more commonly in adults. MethodsForty-two patients (11 children, 32 adults) with choledochal cyst disease were treated primarily at this institution between 1976 and 1993. Patient presentation, clinical evaluation, and operative treatment were obtained from existing records. Long-term follow-up was obtained by records, physician, or direct patient contact. ResultsOne child-but no adults-had the classic triad of jaundice, abdominal mass, and pain. Children were more likely to have two of the three signs or symptoms (82% vs. 25%; p = < 0.05). Adult patients most commonly had abdominal pain and were thought to have pancreatitis (23%) or acute biliary tract symptoms, prompting cholecystectomy (50%). The type of choledochal cyst seen in children and adults was similar; the fusiform extrahepatic (Type I) was most common (50%), and the combined intrahepatic and extrahepatic (Type IVA) was the next most prominent (33%). For both children and adults, treatment consisted of excision of the cyst and biliary reconstruction with a hepaticojejunostomy. There was no surgical mortality. Gallbladder or cholangiocarcinoma was identified in three adults (9.7%), two of which were manifest on presentation. Long-term follow-up revealed one patient with a biliary stricture and three patients with Type IVA cysts who had intrahepatic stones. ConclusionsChildren and adults differ in presentation of choledochal cysts, with adults commonly having acute biliary tract or pancreatic symptoms. Surgical treatment with cyst excision and biliary bypass is safe and effective in children and adults with excellent long-term results that minimize the development of malignancy. 644

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

“…In addition, the increased likelihood of associated hepatobiliary disease, as well as previous surgery makes management in adults more complex [8] . Although the classical clinical triad of abdominal pain, jaundice and right hypochondriac mass has been reported in children, most patients (71 cases) described here had symptoms that were chronic and intermittent, often resulting in delayed diagnosis [9] . Furthermore, secondary hepatobiliary disease in adults may obscure the primary problem and compound the complexities of subsequent surgery [10][11][12][13] .…”

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

“…3,6,13,14 It may be congenital or acquired. The most common lesion reported is in the CBD (or choledochus), hence the term choledochal cyst.…”

Familial occurrence of congenital bile duct dilatation

“…Congenital choledochal cyst is a relatively rare disease and its incidence is between 1 in 130 000 and 1 in 2 million [10] . There is a female predominance (ratio 1:3) [11,12] and the lesions are more common in Asians, with the majority of reported cases in Japan [11] .…”