Abstract
Four infants in whom choledochal cyst was diagnosed by maternal ultrasound examinations are reviewed. The infants, from different institutions, represent a spectrum with regard to clinical presentation and subsequent course. They show that choledochal cyst can develop at different stages of gestation and is often not associated with biliary obstruction or biliary atresia. Definitive surgery can be safely performed in the neonatal period and is the treatment of choice. Follow-up data indicate that despite marked differences in the initial severity of their hepatic parenchymal disease, all four infants have done well in their early years, with essentially normal liver function. These unique patients provide insights into the possible etiology and pathophysiology of choledochal cyst and suggest guidlines for future evaluation and management of such infants.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Babbitt DP (1969) Congenital choledochal cysts: new etiological concept based on anomalous relationships of common bile duct and pancreatic bulb. Ann Radiol 12: 231–240
Barlow B, Tabor E, Blanc WA, Santulli TV, Harris RC (1976) Choledochal cyst: a review of 19 cases. J Pediatr 89: 934–940
Campbell S, Pearce JM (1983) Ultrasound visualization of congenital malformations. Br Med Bull 39: 322–331
Dewbury KC, Aluwihare ARP, Burch SJ, Freeman NV (1980) Prenatal ultrasound demonstration of a choledochal cyst. Br J Radiol 53: 906–907
Dibbins AW, Curci MR, McCrann DJ (1985) Prenatal diagnosis of congenital anomalies requiring surgical correction. Am J Surg 149: 528–533
Filler RM, Stringel G (1980) Treatment of choledochal cyst by excision. J Pediatr Surg 14: 437–442
Frank JL, Hill MD, Chirathivat S, Sfakianakis GN, Marchildon MB (1981) Antenatal observation of a choledochal cyst by ultrasound. AJR 137: 166–168
Gauderer MWL, Jassani MN, Izant R Jr (1984) Ultrasonographic antenatal diagnosis: will it change the spectrum of neonatal surgery? J Pediatr Surg 19: 404–407
Hays DM (1980) Current classification and variant forms of biliary atresia. In: Hays DM, Kimura K (eds) Biliary atresia. Harvard University Press, Cambridge, pp 52–58
Hays DM (1980) In commentary on: Miyano T, Suruga K, Soul-Chin C. A clinicopathologic study of choledochal cyst. World J Surg 4: 231
Hill LM, Breckle R, Gehrking WC (1983) The prenatal detection of congenital malformations by ultrasonography. Mayo Clin Proc 58: 805–826
Howell CG Jr, Templeton JM Jr, Weiner S, Glassman M, Betts JM, Witzleben CL (1983) Antenatal Diagnosis and early surgery for choledochal cyst. J Pediatr Surg 18: 387–393
Jona JA, Babbitt DP, Starshak RJ, La Porta AJ, Glicklich M, Cohen RD (1979) Anatomic observations and etiologic and surgical considerations in choledochal cyst. J Pediatr Surg 14: 315–320
Kato T, Hebiguchi T, Matsuda K, Yoshino H (1981) Action of pancreatic juice on the bile duct: pathogenesis of congenital choledochal cyst. J Pediatr Surg 16: 146–151
Kato O, Hattori K, Suzuki T, Tachino F, Yuasa T (1983) Clinical significance of anomalous pancreatobiliary union. Gastrointest Endosc 29: 94–98
Kimura K, Tsugawa C, Ogawa K, Matsumoto Y, Yamamoto T, Kubo M, Asada S, Nishiyama S, Ito H (1978) Choledochal cyst: etiological considerations and surgical management in 22 cases. Arch Surg 113: 159–163
Landing BH (1974) Considerations of the pathogenesis of neonatal hepatitis, biliary atresia, and choledochal cyst — the concept of infantile obstructive cholangiopathy. Prog Pediatr Surg 6: 113–137
Lebenthal E, Lee PC, Heibringer LA (1983) Impact of development of gastrointestinal tract on infant feeding. J Pediatr 102: 1–9
Lilly JR (1979) The surgical treatment of choledochal cyst. Surg Gynecol Obstet 149: 36–42
Rento JJ, Bailly G, Toussanint D, Cussenot J (1981) Kyste congenital choledoque chez le nouveau ne. J Gynecol Obstet Biol Reprod 10: 61–65
Schmitt M, Grosdidier D, Rose E (1982) Dilatation kystique congenitale du choledoque. Ann Medicales de Nancy et de L'est 21: 481–484
Todani T, Tabuchi K, Watanabe Y, Kobayashi T (1979) Carcinoma arising in the wall of congenital bile duct cysts. Cancer 44: 1134–1141
Tsuchida Y, Saito S, Honna T, Hirata A, Shiraki K (1980) Morphologic studies on congenital bile duct cyst with reference to the intrahepatic involvement. In: Kasai M, Shiroko K (eds) Cholestasis in infancy. University Park Press, Baltimore, pp 207–216
Vater A (1723) Dissertation in auguralis medica proes. Diss qua scirrhis viscerum disseret. CS exlerus 70: 19 (University Library, Edinburgh)
Wong KC, Lister J (1981) Human fetal development of the hepatopancreatic duct junction — a possible explanation of congenital dilatation of the biliary tract. J Pediatr Surg 16: 139–145
Yamashiro Y, Miyano T, Suruga K, Shimomura H, Suda K, Matsumoto M, Nittono H (1984) Experimental study of pathogenesis of choledochal cyst and pancreatitis; with special reference to the role of bile acids and pancreatic enzymes in the anomalous choledocho-pancreatico ductal junction. J Pediatr Gastroenterol Nutr 3: 721–727
Yotuyanagi S (1936) Contributions to the aetiology and pathogeny of idiopathic cystic dilatation of the common bile duct with report of three cases: a new aetiological theory based on supposed unequal epithelial proliferation at the stage of the physiological epithelial occlusion of the primitive choledochus. Gann 30: 601–650
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Marchildon, M.B. Antenatal diagnosis of choledochal cyst: the first four cases. Pediatr Surg Int 3, 431–436 (1988). https://doi.org/10.1007/BF00173461
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00173461