Clinical analysis of Choledochal cyst.
- Author:
Yong Hoon CHO
1
;
Tae Yong JEON
;
Hae Young KIM
;
Mun Sup SIM
Author Information
1. Department of Surgery, College of Medicine, Pusan National University, Pusan, Korea.
- Publication Type:Original Article
- Keywords:
Choledochal cyst;
Todani's classification;
Surgical excision
- MeSH:
Abdominal Pain;
Age Distribution;
Anastomotic Leak;
Biliary Tract;
Bilirubin;
Child;
Cholangiopancreatography, Endoscopic Retrograde;
Cholangitis;
Choledochal Cyst*;
Choledocholithiasis;
Choledochostomy;
Classification;
Dilatation;
Early Diagnosis;
Female;
Fever;
Hepatitis;
Humans;
Hypertension, Portal;
Jaundice;
Liver Cirrhosis, Biliary;
Male;
Mortality;
Pancreatitis;
Postoperative Period;
Prognosis;
Rupture;
Tomography, X-Ray Computed;
Wounds and Injuries
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
1999;3(2):39-47
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Choledochal cyst may be defined as cystic dilatation of biliary tree, and prone to complications such as recurrent cholangitis, pancreatitis, choledocholithiasis, biliary cirrhosis, portal hypertension, cystic rupture and carcinoma. It is found usually in childhood(more than 60%). The clinical symptoms are characterized by abdominal pain, jaundice and a palpable abdominal mass. It can be diagnosed with abdominal US, abdominal CT, ERCP but the usefullness of ERCP is limited by its invasiveness. In 1977, Todani classified choledochal cyst to 5 types and many clinicians use this classification in these days. Principle of treatment is surgical excision due to its complication, so excision of the cyst with Roux-en- Y hepaticojejunostomy is common procedure. We retrospectivly reviewed 18 patients who were finally diagnosed as choledochal cyst from Jan, 1993 to June, 1998 at PNUH(Pusan National University Hospital). The ratio of female to male was 5 : 1, and their age distribution range from 3-day to 77-year old(less than 10-year old in 61.1%). Their chief complaints were abdominal pain(50.0%), jaundice( 38.9%), fever & chill(33.3%), palpable abdominal mass(22.2%) and symptomatic duration was less than 1 month in 72.2%. In laboratory findings; serum ALT level was elevated in 61.1%, ALP in 50.5%, Bilirubin in 38.9%. Almost all patients were diagnosed with US & CT, and preoperative diagnostic rate was 83.3%. According to Todani's classification; Type I was found in 11 patients(61.1%), Type II in 1(5.6%), Type IVa in 6(33.3%). Associated disease with choledochal cyst was found in nine patients; choledocholithiasis in four patients, cholangitis in two patients, pancreatitis in two patients, hepatitis in one patient. All patients were managed by operation; Cyst excision with Roux-en-Y hepaticojejunostomy in sixteen patients(88.8%), Cyst excision with Roux-en-Y choledochojejunostomy in one case(5.6%), Cyst excision with Roux-en-Y hepaticojejunostomy & T-tube choledochostomy in one case(5.6%). There was no anastomotic leakage and operative mortality, but pancreatitis(16.7%), cholangitis(11.1%), wound infection(5.6%) were complicated in the postoperative period. It is significant to have early diagnosis and early management such that we can expect better prognosis.
