PURPOSE: The level of bile amylase in a choledochal cyst varies although the theory of pancreaticobiliary reflux through an anomalous pancreaticobiliary duct union (APBDU) is widely accepted as a cause of choledochal cysts. The aim of this study was to evaluate the clinical characteristics of choledochal cysts according to the level of bile amylase in the cyst. METHODS: During the last 17 years, 59 pediatric choledochal cyst patients were surgically treated at the division of Pediatric Surgery, Keimyung University Dongsan Medical Center. Of those patients, 42 in whom the level of bile amylase in the cyst was measured at operation were included in this study. The age, duration clinical findings, anatomical types and the types of Anomalous pancreaticobiliary duct union (APBDU) were analyzed after subdividing the patients into 3 groups according to the bile amylase activity in their cysts: group N, <100 U/L, group 1, 100 U/L~0, 000 U/L, and group 2, >10, 000 U/L. RESULTS: The mean ages in groups 1, 2, and N were 5.0+/-4.7 years, 6.2+/-3.7, and 1.7+/-2.4 years, respectively with group 2 being the eldest (P=0.005). Eighty percent of group 2 had long histories of symptom duration (longer than 1 month), with recurrent abdominal pain and/or hospitalization and the diagnosis of pancreatitis, which was also higher than the 37 and 42% in groups N and 1, respectively (P=0.038). Jaundice and an abdominal mass were the predominant symptoms in the group N, whereas abdominal pain, jaundice and vomiting were predominant in the groups 1 and 2. According to the Todani's classification, the incidence of type IV was higher than type I in all groups, with the ratio of 1: 2. According to the Komi's classification of the APBDU, the incidence of Komi I and II in groups 1 and 2 were similar, with the ratio of 1: 2. CONCLUSION: The level of bile amylase in choledochal cysts was significantly higher with advancing age, especially in patients having a long history of recurrent attacks of abdominal pain and pancreatitis. However, there were no significant difference among the 3 groups with respect to the anatomical cyst type and type of APBDU. Therefore, further studies are necessary to determine the correlation between the cyst type and the pathogenesis and pathophysiology, and the see if choledochal cysts have a close relationship with APBDU and pancreatitis.
Abdominal Pain ; Amylases* ; Bile* ; Choledochal Cyst* ; Classification ; Diagnosis ; Hospitalization ; Humans ; Incidence ; Jaundice ; Pancreatitis ; Vomiting

Choledochal cysts are rare congenital anomalies which are principally diagnosed by disproportional dilatation of the extrahepatic bile ducts. In addition, choledochal cysts are believed to arise from the anomalous union of the common bile duct and pancreatic duct outside the duodenal wall which is also proximal to the sphincter of the Oddi mechanism. The various types of choledochal cysts have been classified on the basis of these anomalous unions (Komi classification) and their anatomical locations (Todani classification). The multidetector computed tomography with reformatted imaging, magnetic resonance cholangiopancreatography, and an endoscopic retrograde cholangiography represent the important techniques providing the anatomical resolution and detail required to properly diagnose and classify choledochal cysts and their associated abnormal features of the biliary tree, as well as their pancreaticobile duct union. This study describes the various imaging features of a choledochal cyst in adults according to the various types of anomalous unions of the pancreaticobile duct according to Komi's classification and anatomic location according to Todani's classification. Lastly, we also review and discuss the associated abnormal findings developed in biliary systems.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/classification/*diagnosis ; Humans ; Pancreatic Ducts/abnormalities

PURPOSE: Choledochal cysts are congenital dilatations of the biliary tract and are generally surgically excised. Laparoscopic total excision of choledochal cysts and hepaticojejunal biliary tract reconstruction has gained acceptance among pediatric surgeons. We report our early experience with this procedure. METHODS: From May 2013 to April 2016, 10 consecutive patients (7 females and 3 males) underwent laparoscopic choledochal cyst excision and hepaticojejunostomy at our center. We retrospectively reviewed their medical records for age, sex, clinical symptoms, Todani classification, anomalous pancreaticobiliary duct union, operative time, starting day for enteral feeding, complications, and hospital stay. RESULTS: The median patient age was 22 months. Four patients were aged less than 6months, 3 of whom received prenatal diagnosis using ultrasonography. Patients presented with abdominal pain, jaundice, vomiting and fever. No abdominal mass was palpated in any patient. One patient was classified as Todani type Ia, 4 as Ic, and 5as IVa. Six patients had an anomalous pancreaticobiliary duct union. The mean operative time was 319.4 minutes. There were no surgery-related complications. Sips of water were allowed from mean postoperative day 2.4 and regular diet from mean postoperative day 3.4. The mean hospital stay was 6.5 days. CONCLUSION: Laparoscopic excision of choledochal cyst and hepaticojejunostomy in children is feasible with favorable cosmesis.
Abdominal Pain ; Biliary Tract ; Child ; Choledochal Cyst* ; Classification ; Diet ; Dilatation ; Enteral Nutrition ; Female ; Fever ; Humans ; Jaundice ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Prenatal Diagnosis ; Retrospective Studies ; Surgeons ; Ultrasonography ; Vomiting ; Water

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.
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