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PubMedDate not supplied

Complicated choledochal cysts.

Choledochal cysts have a potential for causing a variety of complications. This article presents the incidence, types, and presentation of complications in patients with choledochal cysts and the results of surgery in these patients. Prospectively collected data of 81 patients with choledochal cysts treated at a tertiary care center were retrospectively analyzed. Sixteen (20% of surgical patients; 100% of study group) patients were found to have a complicated choledochal cyst that either manifested as an atypical presentation or necessitated a change in the treatment planning. Eight (50%) of these patients had complications of infective nature, and another 8 (50%) had noninfective complications. Fifteen (94%) patients with complications were adults and 11 (63%) patients had Todani type-IVa cysts; a cystic type of intrahepatic component in 10 patients. Five (31%) patients had undergone prior cystenteric drainage operations. Excision of the choledochal cyst was possible in 14 (88%) patients under both emergency and elective situations; cyst excision was performed in the second stage after an initial external drainage procedure in two of these patients. There was no mortality and no major postoperative complications. Complications of choledochal cysts are more likely in adult patients and in those with both intra- and extrahepatic cysts (Todani type-IVa). Despite the presence of complications, the choledochal cyst can be safely excised in a majority of patients.

Adolescent↗
PubMed1994

Surgical management of choledochal cysts.

Choledochal cysts are an unusual cause of biliary obstruction with up to 85% of reported cases being of the type I variety, that is, fusiform dilations of the common bile duct. Recommended management of this type I cyst is complete surgical excision; however, difficulties arise in type IVa cysts when the cystic dilation extends up into the intrahepatic biliary tree. The purpose of this study is to review the management of choledochal cysts with particular reference to the type IVa variety. Statistical analysis of outcome differences was undertaken using Fisher's exact test. A total of 23 consecutive patients with choledochal cysts seen at our institution in a 5-year period were reviewed: 8 patients had type I cysts, 1 patient had a type III cyst, and 14 patients had type IVa cysts. All type I cysts underwent complete cyst excision with hepaticojejunostomy and modified Houston loop formation. Of 14 patients with type IVa cysts, 13 underwent complete excision of the extrahepatic portion of the cyst with hepatico- and cystojejunostomy and modified Hutson loop formation. One patient required hepatic lobectomy. With a mean follow-up of 33 months, 4 patients with type IVa choledochal cyst have had episodes of recurrent cholangitis, with access to the library tree being achieved via the Hutson loop in 3 of the 4 patients. Three of these cases represented anastomotic strictures that were treated nonoperatively. We concluded that recurrent cholangitis and anastomotic stricture after resection of type IVa choledochal cysts is frequent and recommend Hutson loop formation at the time of primary resection.

Adolescent↗
PubMed1997

Acute pancreatitis complicating pregnancy in a patient with co-existing choledochal cyst.

Choledochal cyst, although more common in females than in males, has only rarely been encountered in association with pregnancy. A 29-year-old nulliparous woman at 32nd week gestation was diagnosed as acute pancreatitis with co-existing type l choledochal cyst. Resection of the choledochal cyst was performed and a Roux-en-Y hepatico-jeunostomy was carried out to provide biliary drainage. Although the preferred management of a choledochal cyst is excision and Roux-en Y reconstruction, this may have to be deferred until after delivery, depending on gestational age, because of the risk of fetal mortality and maternal morbidity that is associated with this procedure.

Acute Disease↗
PubMed1998

A contribution to the casuistics of choledochal cysts.

Choledochal cyst is a rare cystic anomaly of bile ducts, primarily affecting the choledochus. The etiology of the disease is unknown, while the symptoms predominated by cholangitis usually occur by the age of thirty. The complications of untreated disease include septic complications, biliary cirrhosis, formation of concrements in cystically dilated bile ducts, and a potential risk of cholangiocarcinoma. Two patients with choledochal cysts type III and IV are presented. The patient with type III choledochal cyst underwent radical treatment, whereas in the patient with type IV choledochal cyst only a palliative procedure could be used. Both patients were men older than 40, and were free from the disease associated sequels for two and five years after the surgery.

Adult↗
PubMed1997

Choledochal cysts.

Choledochal cysts are a relatively rare abnormality in the West but are more common in the East. The etiology of choledochal cysts remains unknown. Recently, the incidence in neonates and young infants has been increasing due to advances in diagnostic imaging, including antenatal diagnosis. Choledochal cysts can present at any age, but the clinical manifestation differs according to the age of onset. Early diagnosis followed by cyst excision is the treatment of choice, even in asymptomatic children. Recently, attention has been paid to the treatment of intrahepatic and intrapancreatic ductal diseases such as intrahepatic duct dilatation, debris in the intrahepatic ducts, and protein plugs in the common channel. Intraoperative cyst endoscopy is strongly recommended as a valuable adjunct to cyst excision for the prevention of postoperative complications due to intrahepatic or intrapancreatic ductal diseases.

Adolescent↗
PubMed1997

Endoscopic retrograde cholangiopancreatography in the diagnosis and management of choledochal cysts.

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionally, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

Adult↗
PubMed1995

Imaging of the choledochal cyst.

Choledochal cysts are rare and usually manifest in infancy and childhood. They are considered congenital because they occur in fetuses and neonates. Their origin may be related to an abnormal connection between the pancreatic duct and common bile duct and chronic reflux of pancreatic juice into the bile duct, resulting in irritation of the duct and subsequent dilatation. Choledochal cysts appear as cystic or fusiform dilatation of the common bile duct at radiography. Ultrasonography is the best initial method of evaluating dilatation of the intra- and extrahepatic bile ducts. Computed tomography is considered to be more accurate in delineating the intrahepatic biliary tree. Hepatobiliary scintigraphy with technetium-99m disofenin provides physiologic information on hepatic uptake and accumulation of radionuclide in the dilated biliary tree. Endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and intraoperative cholangiography are definitive studies that demonstrate anatomic details of the biliary tree and the pancreaticobiliary ductal junction.

Adolescent↗
PubMed1980

A clinicopathologic study of choledochal cyst.

Choledochal cyst is quite common in Japan. The etiology of this lesion is not clear, and there remain problems in its treatment as well. Radiologic investigation of the distal common bile and pancreatic ducts was performed by operative cholangiography and endoscopic retrograde cholangiopancreatography. Anomalies at the junction of these ducts were found in all of the patients. Localilzed cystic dilatation of the extra-hepatic bile ducts without intrahepatic bile duct dilatation was produced experimentally by ligation of the distal choledochus in infant rats. Concerning the etiology, we agree with Babbitt's hypothesis that weakness of the choledochal wall is produced by reflux of pancreatic juice via an anomalous choledochopancreatic junction. We think that the stenosis associated with this anomaly is the critical factor. From our follow-up study of 30 cases, we find excision of the cyst to be the most important part of treatment. Choledochal cysts presenting under 6 months of age had clinical symptoms and pathology similar to biliary atresia.

Age Factors↗
PubMedDate not supplied

[Surgical revision and correction of choledochal cysts].

Choledochal cyst are a rare congenital abnormality, seldom treated by the General Surgeon. We report six cases of re-operation found on a eighth year period. Six cysts type I, and one type II (Todani's Classification) were found. On five of them, an internal derivation had been performed, in one patient only a celiotomy was performed, and in another one a colecistectomy. Complete resection of the cyst was performed in six cases. In one female patient, this was impossible, because a carcinoma was found, she died postoperatively. We recommend external bile duct drainage for those cases where a complete resection can not be performed. This option alleviates the symptoms, allows morphological studies and do not compromise the final procedure which must be the complete excision of the cyst.

Adolescent↗
PubMed2000

Spontaneous rupture of choledochal cyst.

Choledochal cyst in an uncommon congenital anomaly with classic presentation triad of abdominal pain, jaundice and right upper abdominal mass. Presentation due to biliary peritonitis following cyst rupture is extremely rare. One such case which was successfully treated is being reported.

Choledochal Cyst↗
PubMed1989

Radiologic approach to choledochal cysts.

Choledochal cysts, being uncommon and having a nonspecific presentation, require a high index of suspicion for their diagnosis. In this series of 11 patients, the correct diagnosis was established in all using a combination of real-time ultrasound (US) scanning (9 positive) and endoscopic retrograde cholangiopancreatography (ERCP; 10 positive). Real-time US is suitable as the initial imaging modality and ERCP is complementary.

Adolescent↗
PubMed1985

Asymptomatic choledochal cyst.

Choledochal cyst is a rare cystic malformation of the extrahepatic bile ducts. In all previous reports patients were investigated either for symptoms suggesting hepatobiliary disease or for laboratory data suggestive of biliary obstruction. We report a completely asymptomatic patient with normal hepatic function whose cyst was discovered serendipitously during sonogram to determine renal size.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1993

Choledochal cyst: personal experience in the management of choledochal cyst.

Choledochal cysts are uncommon in Zambia, but are frequently misdiagnosed and consequently mistreated. It is recommended that anastomotic drainage of the cyst into the duodenum or jejunum should be done as a first stage procedure on severely sick patients seen in rural hospitals, prior to their transfer to major hospitals where definitive procedure such as end to end anastomosis of the common bile duct or Roux-en Y choledochojejunostomy can be performed. Our experience of five cases seen over seven years is reported.

Adolescent↗
PubMed1999

Bile duct cancer developed after cyst excision for choledochal cyst.

Oncogenesis after cyst excision for choledochal cyst and suitable surgical procedures for this operation are discussed. The clinical data of 23 patients with cancer of the biliary tree after excision of choledochal cyst reported in the English-language and Japanese literature were reviewed, and data for 1353 Japanese patients with choledochal cyst and/or pancreaticobiliary malunion were analyzed. In the 23 patients reported in the literature, age at cyst excision ranged from 1 to 55 years (average, 23.0 +/- 13.7 years), and cancers were detected at age 18-60 years (average, 32.1 +/- 12.2 years), with intervals between cyst excision and cancer detection of 1-19 years (average, 9.0 +/- 5.5 years). Sites of cancer development were: intrahepatic, six; anastomotic, eight; hepatic side residual cyst, three; and the intrapancreatic duct, six. In the Japanese patients with choledochal cyst and/or pancreaticobiliary malunion, the incidence of cancer associated with primary choledochal cyst and/or pancreaticobiliary malunion was 16.2% (219/1353). The incidence of cancer development after cyst excision in this population, of whom 1291/1353 underwent surgery, was assumed to be 0. 7%. Nearly half of the 23 patients in the literature had undergone inadequate cyst excision. Oncogenesis of cancers after cyst excision is possibly different from that of choledochal cysts.

Adolescent↗
PubMed2003

Smallest Todani's type II choledochal cyst.

A choledochal cyst is defined as an isolated or combined congenital dilation of the extra hepatic or intrahepatic biliary tree. Todani and colleagues proposed the five types of congenital choledochal cysts which have gained widespread acceptance. Type II choledochal cyst, a diverticulum of common bile duct, is rarest, and most reported cases of Type II were as large as several centimeters in size. We herein report the case of a small Type II choledochal cyst which was resected at pancreatoduodenectomy for carcinoma of the papilla of Vater. A 58-year-old Japanese male was referred to our hospital for the evaluation of jaundice. Preoperative cholangiogram via the percutaneous transhepatic biliary drainage tube revealed a complete obstruction at the narrow terminal segment. Furthermore, a small diverticular protrusion was demonstrated on the lower part of the common bile duct. The resected specimen showed a 2.2 x 1.7 x 1.2 cm carcinoma of the major papilla, and a deep, 2 mm in diameter and 5 mm in depth, depression on the posterior wall of the common bile duct. The anomalous pancreatobiliary duct was not seen. The deep depression was confirmed microscopically to penetrate the fibromuscular layer of the common bile duct and diagnosed as a Todani's Type II choledochal cyst. To our knowledge, the current case is the smallest Type II choledochal cyst which was completely resected.

Cholangiography↗
PubMed1997

Malignant change in the biliary tract after excision of choledochal cyst.

BACKGROUND: Choledochal cyst is a rare congenital condition with a high risk of malignant change if untreated. The risk of malignancy after surgical excision of choledochal cyst is not known. METHODS: Forty-eight patients with choledochal cysts managed over a 21-year period were reviewed, to determine the risk of malignant change after cyst excision. Thirty-nine of 48 patients had no carcinoma at first admission; their mean(s.d.) age was 20(18) years. Thirty-seven of 39 patients underwent cyst excision and cholecystectomy followed by hepaticoenterostomy. RESULTS: Cyst excision was incomplete in 28 of the 37 patients because dilated portions of the biliary ducts remained proximally and/or distally. In these 37 patients, no carcinoma has developed in the remnant proximal hepatic duct or the terminal bile duct after mean(s.d.) follow-up of 9.1(6.4) years. In the remaining nine patients, biliary carcinoma was diagnosed at the first visit. Six patients died from recurrence with a mean(s.d.) survival time of 13(11) months, while three patients were alive and free from recurrence 2 months, 1 year and 7 years after operation. CONCLUSION: Malignant change has not been observed after total or subtotal excision of choledochal cysts in this series.

Adolescent↗
PubMed2003

Management dilemmas with choledochal cysts.

CONTEXT: Choledochal cysts are rare and of unknown cause. Their presentation is protean, with the classical triad of pain, jaundice, and mass rarely seen. The potential complications are serious, including pancreatitis, cholangitis, and cholangiocarcinoma. OBJECTIVE: To present the current experience and evidence relating to all aspects of choledochal cysts to derive appropriate management recommendations. METHODS: Review of relevant literature in the English language indexed on MEDLINE. RESULTS: The elaboration of the classification of choledochal cysts. We describe the modes of presentation and optimal investigation and summarize the current theories on etiology and malignant transformation. The results of different management strategies are presented. CONCLUSIONS: Choledochal cysts are often detected during the investigation of nonspecific symptoms, or even incidentally detected. Magnetic resonance imaging is the best imaging modality for the diagnosis and characterization of these cysts. Complete excision and hepaticojejenostomy is the management of choice.

Anastomosis, Surgical↗
PubMed1999

Choledochal cyst associated the with anomalous union of pancreaticobiliary duct (AUPBD) has a more grave clinical course than choledochal cyst alone.

OBJECTIVE: Since choledochal cyst is frequently associated with the anomalous union of pancreaticobiliary duct (AUPBD), AUPBD has been regarded to be the etiologic factor of choledochal cyst. However, the clinical significance of AUPBD an patients with choledochal cyst has not been clearly defined. Therefore, to clarify the significance of AUPBD in choledochal cyst patients, we compared the clinical features of patients with choledochal cyst according to the presence or absence of AUPBD. METHODS: Among 52 cases which were diagnosed as choledochal cyst out of 5,037 ERCP referrals between August 1990 and December 1996, we selected 44 cases, in which the pancreaticobiliary junction was clearly visualized on cholangio-pancreaticography. These cases were divided into AUPBD-present group (n = 28) and AUPBD-absent group (n = 16). Clinical features were compared between the two groups. Furthermore, in AUPBD-present group, clinical data were also analyzed according to Kimura's classification of AUPBD. RESULTS: In our study, AUPBD was associated with choledochal cyst in 28 (64%) cases. AUPBD was found only in type I and IV according to Todani's classification of choledochal cyst. There were no significant differences between the AUPBD-present group and the AUPBD-absent group in the incidence of gallstone disease, while the incidence of acute inflammation was 93% (26/28) in the AUPBD-absent group (p < 0.01). Carcinoma developed only in the AUOBD-present group (9/28, 32%) (p < 0.05). Pancreatic disorders (i.e. pancreatic stone, pancreatitis or pancreatic cancer) occurred in 12 of 28 cases in the AUPBD-present group (43%), while only in 1 of 16 cases in the AUPBD-absent group (6%) (p < 0.05). CONCLUSION: AUPBD associated with choledochal cyst may have implications not only as a possible etiologic factor but also as an important factor that may affect the clinical course, surgical planning and prognosis. In cases with choledochal cyst, we should make an effort to evaluate the presence of AUPBD.

Adolescent↗