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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Differential diagnosis of infantile choledochal cyst with or without biliary atresia
1Department of Pediatrics, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. huang817@adm.cgmh.org.tw
Insights
Infants with choledochal cysts associated with biliary atresia (BACH) present differently than those without (CH). Ultrasonography, especially when considering cyst size and gallbladder status, improves BACH diagnosis accuracy.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Choledochal cysts are cystic dilatations of the biliary tree in infants.
- These cysts can be associated with biliary atresia (BACH) or occur without it (CH).
- Infants often present with similar symptoms, but management and prognosis differ significantly.
Purpose of the Study:
- To compare clinical and laboratory findings between infants with choledochal cysts with and without biliary atresia.
- To evaluate the diagnostic accuracy of ultrasonography and intravenous radionuclide cholangiography (IVRC) in diagnosing BACH in infants.
Main Methods:
- Retrospective review of 29 infants under 1 year with surgically proven choledochal cysts (1991-2004).
- Patients were categorized as CH (18) or BACH (11).
- Preoperative abdominal ultrasonography and IVRC were performed.
Main Results:
- BACH infants showed no sex predominance, prolonged jaundice, clay-colored stools, and higher bilirubin levels compared to CH infants.
- Ultrasonography improved BACH diagnosis accuracy to 93.1% when considering extrahepatic cystic dilatation diameter ≤1.5 cm and a non-atretic gallbladder.
- IVRC demonstrated a diagnostic accuracy of 84.2% for BACH.
Conclusions:
- Clinical and laboratory differences exist between choledochal cysts with and without biliary atresia.
- Abdominal ultrasonography accuracy for BACH diagnosis is enhanced by specific criteria (cyst size, gallbladder status).
- Hepatobiliary scintigraphy (IVRC) is less accurate than ultrasonography but useful for excluding BACH.
Background:
The choledochal cyst, a cystic dilatation of the biliary tree, in infancy may be associated with biliary atresia (BACH) or without biliary atresia (CH). Infants in both groups usually have similar clinical symptoms at presentation but different management and prognosis.
Methods:
We retrospectively identified 29 infants, aged younger than 1 year, who had surgically proven choledochal cysts from 1991 to 2004. They were diagnosed as CH in 18 patients and BACH in eleven. They had undergone preoperative abdominal ultrasonography (29 patients) and intravenous radionuclide cholangiography (IVRC) (19 patients).
Results:
The comparison of the clinical characteristics and laboratory examinations between the two groups showed that BACH patients had no sex predominance contrasting to female predominance in CH patients, more often presented with prolonged jaundice and clay-colored stool, and had higher bilirubin levels. In diagnosing BACH by ultrasonography, using the diameter of the extrahepatic cystic dilatation < or =1.5 cm but not atretic gallbladder further increased the sensitivity, specificity, positive and negative predictive rates (81.8%, 100%, 100%, 90% vs 54.5%, 88.8%, 75%, 76.2%, respectively), yielding an increased diagnostic accuracy (93.1% and 75.9%, respectively). In diagnosing BACH by IVRC, the sensitivity, specificity, positive and negative predictive value and diagnostic acCuracy were 100%, 70%, 75%, 100% and 84.2%, respectively.
Conclusions:
We concluded that there were clinical and laboratory discrepancies between the two groups, including female predominance, prolonged jaundice, clay-colored stool, bilirubin levels and size of cyst. In diagnosing BACH, the accuracy of abdominal ultrasonography will be increased if we use the diameter of the extrahepatic cystic dilatation < or = l.5 cm but not atretic gallbladder as one of the diagnostic cretia. Hepatobiliary scintigraphy had less diagnostic accuracy than ultrasonography but can be added to exclude the diagnosis of BACH.
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