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Journal of Gastrointestinal Surgery

, Volume 14, Issue 7, pp 1105–1110 | Cite as

Choledochal Cysts: Differences Between Pediatric and Adult Patients

  • Ching Shui Huang
  • Chi Chen Huang
  • Der Fang Chen
Original Article

Abstract

Choledochal cysts in children and adults are believed to be different, but direct comparison between them is lacking in the literature. This study was aimed to identify the clinicopathological differences between 42 children and 59 adults with choledochal cyst treated by same surgeons at the Cathay General Hospital. The mean follow-up period was 8.9 years. The result showed that the female-to-male ratios were 1.5:1 in pediatric patients and 4.9:1 in adult patients. Compared with adults with choledochal cyst, the pediatric patients presented more abdominal mass (52.4% vs 21.2%, P = 0.002) and less abdominal pain (76.2% vs. 98.0%, P = 0.002), are more frequently associated with anomalous pancreaticobiliary ductal union (85.7% vs. 59.6%, P = 0.005) and sudden severe stenosis of terminal choledochus (76.2% vs. 42.3%, P = 0.001), are less commonly associated with choledocholithiasis, are not associated with malignant transformation (0% vs 21.2%), and have fewer perioperative and long-term complications. Nevertheless, patients who received total excision had fewer surgical complications in both groups. This result shows that choledochal cysts in pediatric and adult patients are different in clinicopathological manifestations, prognosis, and the underlying abnormalities of the pancreaticobiliary system, suggesting that patients with choledochal cyst should be managed according to these differences.

Keywords

Choledochal cyst Difference between pediatric and adult patients Anomalous pancreaticobiliary ductal union 

References

  1. 1.
    Miyano T, Yamataka A, Kato Y, Segawa O, Lane G, Takamizawa S, Kohno S, Fujiwara T. Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases. J Pediatr Surg 1996;31:1417–1421.CrossRefPubMedGoogle Scholar
  2. 2.
    Saing H, Han H, Chan KL, Lam W, Chan FL, Cheng W, Tam PK. Early and late results of excision of choledochal cysts. J Pediatr Surg 1997;32:1563–1566.CrossRefPubMedGoogle Scholar
  3. 3.
    Joseph VT. Surgical techniques and long-term results in the treatment of choledochal cyst. J Pediatr Surg 1990;25:782–787.CrossRefPubMedGoogle Scholar
  4. 4.
    Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 1980;140:653–657.CrossRefPubMedGoogle Scholar
  5. 5.
    Lipsett PA, Pitt HA. Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg 2003;10:352–359.CrossRefPubMedGoogle Scholar
  6. 6.
    Metcalfe MS, Wemyss-Holden SA, Maddern GJ. Management dilemmas with choledochal cysts. Arch Surg 2003;138:333–339.CrossRefPubMedGoogle Scholar
  7. 7.
    Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H, Pawlik TM, Choti MA, Wolfgang CL, Schulick RD. Choledochal cyst disease in children and adults: a 30-year single-institution experience. J Am Coll Surg 2008; 206:1000–1006.CrossRefPubMedGoogle Scholar
  8. 8.
    Hewitt PM, Krige JE, Bornman PC, Terblanche J. Choledochal cysts in adults. Br J Surg 1995;82:382–385.CrossRefPubMedGoogle Scholar
  9. 9.
    Visser BC, Suh I, Way LW, Kang SM. Congenital choledochal cysts in adults. Arch Surg 2004;139:855–860.CrossRefPubMedGoogle Scholar
  10. 10.
    Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wong J. Choledochal cysts in adults. Arch Surg 2002;137:465–468.CrossRefPubMedGoogle Scholar
  11. 11.
    Lenriot JP, Gigot JF, Ségol P, Fagniez PL, Fingerhut A, Adloff M. Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research. Ann Surg 1998;228:159–166.CrossRefPubMedGoogle Scholar
  12. 12.
    Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg 2004;91:1538–1548.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee KF, Lai EC, Lai PB. Adult choledochal cyst. Asian J Surg 2005;28:29–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Cheng SP, Yang TL, Jeng KS, Liu CL, Lee JJ, Liu TP. Choledochal cyst in adults: etiological considerations to intrahepatic involvement. ANZ J Surg 2004;74:964–967.CrossRefPubMedGoogle Scholar
  15. 15.
    de Vries JS, de Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A, Heij HA, Gouma DJ, van Gulik TM. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani's classification. J Pediatr Surg 2002;37:1568–1573.CrossRefPubMedGoogle Scholar
  16. 16.
    Chaudhary A, Dhar P, Sachdev A, Kumar N, Vij JC, Sarin SK, Broor SL, Sharma SS. Choledochal cysts—differences in children and adults. Br J Surg 1996; 83:186–188.CrossRefPubMedGoogle Scholar
  17. 17.
    Tsuchida Y, Takahashi A, Suzuki N, Kuroiwa M, Murai H, Toki F, Kawarasaki H, Hashizume K, Honna T. Development of intrahepatic biliary stones after excision of choledochal cysts. J Pediatr Surg 2002;37:165–167.CrossRefPubMedGoogle Scholar
  18. 18.
    Wu GS, Zou SQ, Luo XW, Wu JH, Liu ZR. Proliferative activity of bile from congenital choledochal cyst patients. World J Gastroenterol 2003;9:184–187.PubMedGoogle Scholar
  19. 19.
    Komi N, Tamura T, Tsuge S, Miyoshi Y, Udaka H, Takehara H. Relation of patient age to premalignant alterations in choledochal cyst epithelium: histochemical and immunohistochemical studies. J Pediatr Surg 1986;21:430–433.CrossRefPubMedGoogle Scholar
  20. 20.
    Komi N, Tamura T, Miyoshi Y, Kunitomo K, Udaka H, Takehara H. Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases. Surg Gastroenterol 1984;3:69–73.PubMedGoogle Scholar
  21. 21.
    Tan SS, Tan NC, Ibrahim S, Tay KH. Management of adult choledochal cyst. Singapore Med J 2007;48:524–527.PubMedGoogle Scholar
  22. 22.
    Stain SC, Guthrie CR, Yellin AE, Donovan AJ. Choledochal cyst in the adult. Ann Surg 1995;222:128–133.CrossRefPubMedGoogle Scholar
  23. 23.
    Babbitt DP, Starshak RJ, Clemett AR. Choledochal cyst: a concept of etiology. Am J Roentgenol Radium Ther Nucl Med 1973;119:57–62.PubMedGoogle Scholar
  24. 24.
    Ono J, Sakoda K, Akita H. Surgical aspect of cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults. Ann Surg 1982;195:203–208.CrossRefPubMedGoogle Scholar
  25. 25.
    Shi LB, Peng SY, Meng XK, Peng CH, Liu YB, Chen XP, Ji ZL, Yang DT, Chen HR. Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China. World J Gastroenterol 2001;7:732–734.PubMedGoogle Scholar
  26. 26.
    Craig AG, Chen LD, Saccone GT, Chen J, Padbury RT, Toouli J. Sphincter of Oddi dysfunction associated with choledochal cyst. J Gastroenterol Hepatol 2001;16:230–234.CrossRefPubMedGoogle Scholar
  27. 27.
    Davenport M, Basu R. Under pressure: choledochal malformation manometry. J Pediatr Surg 2005;40:331–335.CrossRefPubMedGoogle Scholar
  28. 28.
    Matsufuji H, Araki Y, Nakamura A, Ohigashi S, Watanabe F. Dynamic study of pancreaticobiliary reflux using secretin-stimulated magnetic resonance cholangiopancreatography in patients with choledochal cysts. J Pediatr Surg 2006;41:1652–1656.CrossRefPubMedGoogle Scholar
  29. 29.
    Han SJ, Hwang EH, Chung KS, Kim MJ, Kim H. Acquired choledochal cyst from anomalous pancreatobiliary duct union. J Pediatr Surg 1997;32:1735–1738.CrossRefPubMedGoogle Scholar
  30. 30.
    Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263–269.CrossRefPubMedGoogle Scholar
  31. 31.
    Ramage AA, Tedesco FJ, Schuman BM. Asymptomatic choledochal cyst. Am J Gastroenterol 1985;80:816–818.PubMedGoogle Scholar
  32. 32.
    Tanaka M, Ikeda S, Kawakami K, Nakayama F. The presence of a positive pressure gradient from pancreatic duct to choledochal cyst demonstrated by duodenoscopic microtransducer manometry: clue to pancreaticobiliary reflux. Endoscopy 1982;14:45–47.CrossRefPubMedGoogle Scholar
  33. 33.
    Ford EG, Jennings LM, Gleason W, Andrassy RJ. Efficacy of anomalous pancreatic drainage in choledochal cysts correlates with age of presentation and suggests etiology. Am Surg 1987;53:641–646.PubMedGoogle Scholar
  34. 34.
    Nomura T, Shirai Y, Wakai T, Yokoyama N, Sakata J, Hatakeyama K. Narrow portion of the terminal choledochus is a cause of upstream biliary dilatation in patients with anomalous union of the pancreatic and biliary ducts. World J Gastroenterol 2005;11:6503–6507.PubMedGoogle Scholar
  35. 35.
    Kusunoki M, Saitoh N, Yamamura T, Fujita S, Takahashi T, Utsunomiya J. Choledochal cysts. Oligoganglionosis in the narrow portion of the choledochus. Arch Surg 1988;123:984–986.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Ching Shui Huang
    • 1
    • 2
  • Chi Chen Huang
    • 1
    • 3
  • Der Fang Chen
    • 1
    • 3
  1. 1.Division of Gastrointestinal Surgery, Department of SurgeryCathay General HospitalTaipeiTaiwan
  2. 2.Taipei Medical UniversityTaipeiTaiwan
  3. 3.School of MedicineFu-Jen Catholic UniversityTaipeiTaiwan

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