Choledochal cysts in the adult

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery

Background:

• Choledochal cysts are typically diagnosed in childhood but can manifest in adulthood.
• Approximately 20% of choledochal cyst cases are identified in adult patients.
• Adult presentation often involves non-specific biliary symptoms.

Purpose of the Study:

• To review the clinical presentation and surgical outcomes of adult patients with choledochal cysts.
• To evaluate the efficacy of surgical management for choledochal cysts in adults.

Main Methods:

• Retrospective review of nine adult patients who underwent surgery for choledochal cysts between 1974 and 1985.
• Analysis of presenting symptoms, previous biliary surgeries, cyst types, and surgical procedures.
• Assessment of post-operative outcomes, including symptom resolution and complications.

Main Results:

• Common symptoms included right upper quadrant pain, jaundice, pruritus, cholangitis, pancreatitis, hepatomegaly, and abnormal liver function tests.
• Seven patients had a history of prior biliary surgery.
• Eight patients with type I cysts and one with type IVa underwent complete cyst excision and Roux-Y reconstruction, achieving complete symptom resolution without mortality or major complications.

Conclusions:

• Complete surgical excision of choledochal cysts with Roux-Y choledochojejunostomy is the optimal treatment for adult patients.
• This surgical approach leads to excellent outcomes, including resolution of biliary symptoms and prevention of long-term sequelae.
• Adult-onset choledochal cysts are amenable to surgical correction with favorable long-term results.