Emergent biliary drainage for choledochal cyst

Two patients with choledochal cyst who needed an emergent biliary drainage are presented. Case 1: Spontaneous rupture of the cyst was demonstrated by hepatobiliary scintigram in a 21-month-old girl and an emergent T-tube drainage relieved her symptom. Acute obstruction by protein plugs was considered to have caused rapid expansion of the cyst, which resulted in rupture eventually. Case 2: Marked hypoproteinemia was demonstrated in a 29-month-old boy with choledochal cyst. Bile drainage through Foley catheter promptly made the serum protein level elevated above normal range. Portal hypertension due to severely dilated cyst may have increased ascites amount, which caused extracellular fluid shift and protein to be lost into ascites. In both cases the excision of the extrahepatic bile duct and hepaticojejunostomy was carried out successfully later. Treatment of 20 pediatric cases in our institute and the literature were reviewed. Bile drainage would be safer in emergency condition even though it has been suggested that reconstructive surgery may be tolerable. Definitive surgery should be regarded as a procedure with some risk of postoperative complications because asymptomatic cases operated electively had serious ones. Treatment strategy of patients with choledochal cyst is not straightforward and should be arranged based upon their conditions.