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A clinicopathologic study of choledochal cyst

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Abstract

Choledochal cyst is quite common in Japan. The etiology of this lesion is not clear, and there remain problems in its treatment as well.

Radiologic investigation of the distal common bile and pancreatic ducts was performed by operative cholangiography and endoscopic retrograde cholangiopancreatography. Anomalies at the junction of these ducts were found in all of the patients. Localized cystic dilatation of the extrahepatic bile ducts without intrahepatic bile duct dilatation was produced experimentally by ligation of the distal choledochus in infant rats. Concerning the etiology, we agree with Babbitt's hypothesis that weakness of the choledochal wall is produced by reflux of pancreatic juice via an anomalous choledochopancreatic junction. We think that the stenosis associated with this anomaly is the critical factor.

From our follow-up study of 30 cases, we find excision of the cyst to be the most important part of treatment. Choledochal cysts presenting under 6 months of age had clinical symptoms and pathology similar to biliary atresia.

Résumé

Le kyste du cholédoque est fréquent au Japon. L'étiologie de cette lésion est mal connue et le traitement mal défini.

Nous avons étudié, par cholangiographie peropératoire et cholangiowirsungographie rétrograde endoscopique, le segment distal du cholédoque et le canal pancréatique. Dans tous les cas, nous avons observé des anomalies de la jonction de ces canaux. Nous avons pu reproduire expérimentalement, par ligature du cholédoque distal chez des rats de 2 semaines, une dilatation kystique localisée des voies biliaires extrahépatiques, sans dilatation concommittante des canaux intrahépatiques. L'hypothèse étiologique proposée par Babbitt nous parait logique: la paroi cholédocienne est affaiblie par reflux de suc pancréatique à la jonction cholédoco-pancréatique. Nous croyons que le facteur critique est la sténose associée à cette anomalie.

Le follow-up de nos 30 cas indique que l'excision du kyste est le geste thérapeutique le plus important. Dans les kystes du cholédoque chez les enfants de moins de 6 mois, les symptomes et les lésions sont comparables à ceux de l'atrésie biliaire.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Takeshi Miyano M.D., Keijiro Suruga M.D. & Soul-Chin Chen M.D.

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  1. Takeshi Miyano M.D.
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  2. Keijiro Suruga M.D.
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  3. Soul-Chin Chen M.D.
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Miyano, T., Suruga, K. & Chen, SC. A clinicopathologic study of choledochal cyst. World J. Surg. 4, 231–236 (1980). https://doi.org/10.1007/BF02393586

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