Choledochal cysts in children: epidemiology and outcomes

The purpose of the present study was to evaluate the epidemiology and outcomes of choledochal cysts in children.

We performed a retrospective review of the records of all cases of choledochal cyst in children 0-14 years of age presenting at Chiang Mai University Hospital from May 2000 to February 2007. Demographic and clinical data, including laboratory and radiographic studies, as well as surgical and nonsurgical treatments and outcomes, were recorded.

There were 32 patients (25 female) with a mean age at diagnosis of 4.1 years (range: 1 month to 14.8 years). The most common clinical presentation was jaundice (n = 17), followed by abdominal pain (n = 16), nausea/vomiting (n = 10), and abdominal mass (n = 8). Based on the Tondani modification of the Alonso-Lej classification, 20 cases were type I, whereas 9, 2, and 1 of the patients had types IV, V, and II, respectively. Biliary tract infections, including cholecystitis (n = 5) and cholangitis (n = 3), were the most common preoperative complications. Twenty-six patients had definitive surgery consisting of cystectomy with Roux-en-Y hepaticojejunostomy. Postoperative complications were noted in 3 patients and included intestinal obstruction, bleeding, and cholangitis. Three patients died, all younger than 2 years of age (p = 0.022).

The epidemiology of choledochal cysts in Thai children was similar to cases reported from other regions. Early diagnosis and treatment, particularly in children under 2 years of age, should be emphasized, because these patients are at a higher risk for development of chronic liver disease and poor outcome.