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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
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Management of choledochal cyst with portal hypertension

S S Saluja1, P K Mishra, B C Sharma

  • 1Department of Gastrointestinal Surgery, GB Pant Hospital, 1 Jawaharlal Nehru Marg, New Delhi 110002, India. sundeepsaluja@yahoo.co.in

Singapore Medical Journal
|December 14, 2011
PubMed

Insights

Portal hypertension (PHT) is a rare complication of choledochal cysts. Management varies based on the cause, with surgical options for secondary biliary cirrhosis and conservative or endoscopic approaches for other etiologies.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Gastroenterology

Background:

  • Portal hypertension (PHT) is an infrequent complication of choledochal cysts.
  • Management strategies for PHT in choledochal cyst patients are not well-defined due to low incidence and varied causes.

Observation:

  • Three cases of type IVa choledochal cysts with PHT are presented.
  • Causes of PHT included secondary biliary cirrhosis (SBC) in two patients and alcoholic liver disease in one.
  • Clinical manifestations encompassed jaundice, gastrointestinal bleeding, and ascites.

Findings:

  • One patient with SBC underwent successful surgical excision with hepaticojejunostomy.
  • Another patient with cholangitis received endoscopic retrograde cholangiopancreatography (ERCP) stenting.
  • The patient with alcoholic liver disease was managed conservatively for seven years, ultimately succumbing to liver failure.

Implications:

  • Management of choledochal cysts with PHT should be tailored to the severity of liver disease.
  • Surgical intervention is recommended for patients with SBC.
  • Endoscopic stenting may serve as a temporary measure for high-risk individuals.

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