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A review of choledochal cyst in pediatric and adult patients

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Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

A review of 80 pediatric and 13 adult patients with choledochal cyst disease occurring in a multiracial population is presented to define the incidence, clinical pattern, surgical techniques, and complications seen over periods of 30 years (pediatric) and 15 years (adult patients). In pediatric patients, most cases are now being diagnosed at a much earlier age, usually in infancy or early childhood, presumably due to the ready availability of ultrasound. Adult patients, by contrast, present a complex picture of heptobiliary disease, and delay in diagnosis is not uncommon. Jaundice appears to be the predominant symptom and the classical triad (pain, jaundice, and mass) is seldom seen. The surgical technique emphasises complete excision of the cyst, including the distal end, as the critical factor in the prevention of late complications. Avoidance of anastomotic stricture depends on the apposition of gut to healthy duct wall and not on the size of the anastomosis alone. Postoperative results have been excellent with no immediate mortality and no evidence of cholangitis in patients with extrahepatic cysts. The morbidity is related to patients with persistent intrahepatic biliary dilatation, Caroli's disease, and carcinoma. While endoscopic intervention, hepatic resection, and liver transplantation have been utilized in the management of cystic disease in the liver, the outlook for patients with cholangiocarcinoma associated with choledochal cyst remains extremely poor, with no survivors in this series.

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Authors and Affiliations

  1. Department of Paediatric Surgery, Singapore General Hospital, 1 College Drive, 169608, Singapore

    V. T. Joseph

  2. Department of Surgery, Singapore General Hospital, 1 College Drive, 169608, Singapore

    J. Prema Raj

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  1. V. T. Joseph
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Joseph, V.T., Prema Raj, J. A review of choledochal cyst in pediatric and adult patients. J Hep Bil Pancr Surg 3, 396–404 (1996). https://doi.org/10.1007/BF02349783

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  • DOI: https://doi.org/10.1007/BF02349783

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