Abstract
This analysis was undertaken to compare the clinicopathological features of infants with choledochal cysts to those of older children with these entities and to evaluate the surgical outcomes for both subject groups. The medical records of all children admitted to the Cathay General Hospital with choledochal cysts over a 20-year period were retrospectively reviewed. Twenty-five subjects were included and divided into the infant (<1 year at presentation; 8 subjects) and classical pediatric (1–18 years at presentation; 17 subjects) groups. Anatomical subtypes were: IA (16), IC (6), and IVA (3). The median biliary amylase value was markedly elevated for the pediatric group but not for the infant group. Most (82.4%) patients in the pediatric group, but none in the infant group, presented with abdominal pain. Jaundice and clay-colored stool were present in all patients in the infant group but only 35% of those in the pediatric group. All patients underwent choledochocystectomy and Roux-en-Y hepaticojejunostomy with good outcomes. Neonates/infants with choledochal cysts present differently from older children with these entities. Amylase measurements may serve to distinguish biliary atresia with cystic dilatation from choledochal cyst in neonates/infants. Prognosis following radical cyst excision and reconstruction with Roux-en-Y hepaticojejunostomy is excellent.
Similar content being viewed by others
References
Alonso-Lej F, Rever WB Jr, Pessagno DJ (1959) Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg 108:1–30
Ammori JB, Mulholland MW (2009) Adult type I choledochal cyst resection. J Gastrointest Surg 13:363–367
Chen CJ (2003) Clinical and operative findings of choledochal cysts in neonates and infants differ from those in older children. Asian J Surg 26:213–217
Chokshi NK, Guner YS, Aranda A, Shin CE, Ford HR, Nguyen NX (2009) Laparoscopic choledochal cyst excision: lessons learned in our experience. J Laparoendosc Adv Surg Tech A 19:87–91
Delaney L, Applegate KE, Karmazyn B, Akisik MF, Jennings SG (2008) MR cholangiopancreatography in children: feasibility, safety, and initial experience. Pediatr Radiol 38:64–75
Dhupar R, Gulack B, Geller DA, Marsh JW, Gamblin TC (2009) The changing presentation of choledochal cyst disease: an incidental diagnosis. HPB Surg 2009:103739
Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H, Pawlik TM, Choti MA, Wolfgang CL, Schulick RD (2008) Choledochal cyst disease in children and adults: a 30-year single-institution experience. J Am Coll Surg 206:1000–1005
Foo DC, Wong KK, Lan LC, Tam PK (2009) Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision. J Paediatr Child Health 45:28–30
Hong L, Wu Y, Yan Z, Xu M, Chu J, Chen QM (2008) Laparoscopic surgery for choledochal cyst in children: a case review of 31 patients. Eur J Pediatr Surg 18:67–71
Huang CS, Huang CC, Chen DF (2010) Choledochal cysts: differences between pediatric and adult patients. J Gastrointest Surg 14:1105–1110
Ishimaru T, Kitano Y, Uchida H, Kawashima H, Gotoh C, Satoh K, Yoshida M, Kishimoto H, Iwanaka T (2010) Histopathologic improvement in biliary cirrhosis after definitive surgery for choledochal cyst. J Pediatr Surg 45:e11–e14
Kirschner HJ, Szavay PO, Schaefer JF, Fuchs J (2010) Laparoscopic Roux-en-Y hepaticojejunostomy in children with long common pancreaticobiliary channel: surgical technique and functional outcome. J Laparoendosc Adv Surg Tech A 20:485–488
Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW (2009) Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 10:71–80
Lee KH, Tam YH, Yeung CK, Chan KW, Sihoe JD, Cheung ST, Mou JW (2009) Laparoscopic excision of choledochal cysts in children: an intermediate-term report. Pediatr Surg Int 25:355–360
Mishra A, Pant N, Chadha R, Choudhury SR (2007) Choledochal cysts in infancy and childhood. Indian J Pediatr 74:937–943
Paris C, Bejjani J, Beaunoyer M, Ouimet A (2010) Endoscopic retrograde cholangiopancreatography is useful and safe in children. J Pediatr Surg 45:938–942
Shah OJ, Shera AH, Zargar SA, Shah P, Robbani I, Dhar S, Khan AB (2009) Choledochal cysts in children and adults with contrasting profiles: 11-year experience at a tertiary care center in Kashmir. World J Surg 33:2403–2411
Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 52:434–440
Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 2 of 3: diagnosis. Can J Surg 52:506–511
Singham J, Yoshida EM, Scudamore CH (2010) Choledochal cysts. Part 3 of 3: management. Can J Surg 53:51–56
Singhavejsakul J, Ukarapol N (2008) Choledochal cysts in children: epidemiology and outcomes. World J Surg 32:1385–1388
Suzuki M, Shimizu T, Kudo T, Suzuki R, Ohtsuka Y, Yamashiro Y, Shimotakahara A, Yamataka A (2006) Usefulness of nonbreath-hold 1-shot magnetic resonance cholangiopancreatography for the evaluation of choledochal cyst in children. J Pediatr Gastroenterol Nutr 42:539–544
Tipnis NA, Werlin SL (2007) The use of magnetic resonance cholangiopancreatography in children. Curr Gastroenterol Rep 9:225–229
Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K (1977) Congenital bile duct cyst: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 134:263–269
Torrisi JM, Haller JO, Velcek FT (1990) Choledochal cyst and biliary atresia in the neonate: imaging findings in five cases. AJR Am J Roentgenol 155:1273–1276
Tsai MS, Lin WH, Hsu WM, Lai HS, Lee PH, Chen WJ (2008) Clinicopathological feature and surgical outcome of choledochal cyst in different age groups: the implication of surgical timing. J Gastrointest Surg 12:2191–2195
Vijayaraghavan P, Lal R, Sikora SS, Poddar U, Yachha SK (2006) Experience with choledochal cysts in infants. Pediatr Surg Int 22:803–807
Conflict of interest
The authors declare that no financial relationships exist with the organization sponsoring this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hung, MH., Lin, LH., Chen, DF. et al. Choledochal cysts in infants and children: experiences over a 20-year period at a single institution. Eur J Pediatr 170, 1179–1185 (2011). https://doi.org/10.1007/s00431-011-1429-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-011-1429-2