Related Experiment Video
Updated: Jul 12, 2026
Mouse Islet of Langerhans Isolation using a Combination of Purified Collagenase and Neutral Protease
Published on: September 7, 2012
Management of Choledochal Cysts at a Tertiary Care Centre: A Nine-Year Experience from India
Pranav Honnavara Srinivasan1, Amudhan Anbalagan1, Rajendran Shanmugasundaram1
1Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India.
Insights
Choledochal cysts are increasingly diagnosed in adults, presenting with abdominal pain and jaundice. Surgical excision with Roux-en-Y hepaticojejunostomy is the standard treatment, requiring long-term follow-up for complications and malignancy detection.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Choledochal cysts (CCs) are increasingly diagnosed in adult patients, deviating from their typical pediatric presentation.
- Adult CCs often present with symptoms like abdominal pain and jaundice, necessitating consideration in differential diagnoses.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of adult patients with choledochal cysts.
- To highlight the importance of early diagnosis and appropriate surgical intervention for choledochal cysts in adults.
Main Methods:
- Retrospective analysis of 36 adult patients with choledochal cysts managed between January 2010 and December 2018.
- Review of patient data including demographics, symptoms, cyst types, surgical procedures, and complications.
Main Results:
- The median age at presentation was 37 years, with a female predominance (3.5:1). Abdominal pain was the most common symptom, with a median delay of 348 days from symptom onset to referral.
- Type I CCs were most frequent (77.8%). Cyst excision with Roux-en-Y hepaticojejunostomy was the primary surgical approach (80.55%).
- Early and late complications occurred in 58.3% and 13.8% of patients, respectively. Two patients (5.5%) had associated malignancies (cholangiocarcinoma and gallbladder cancer).
Conclusions:
- Choledochal cysts should be considered in adult patients with epigastric/right hypochondrium pain or jaundice.
- Thorough preoperative evaluation and cyst excision with Roux-en-Y hepaticojejunostomy are crucial for effective management.
- Long-term follow-up is essential for managing complications and early detection of malignant transformation.
Background:
Although choledochal cyst disease is seen predominantly in childhood, it is becomingly increasingly diagnosed in adult patients.
Methods:
Data of 36 patients with choledochal cysts managed in our institute between January 2010 and December 2018 were retrospectively analyzed.
Results:
Median age at presentation was 37 years (range: 13-72 years). Female-to-male ratio was 3.5 : 1. All patients were symptomatic, and abdominal pain was the most common symptom. 72.2% had other associated conditions. There was a considerable delay from the onset of symptoms to referral, median duration being 348 days. There were 28 cases of type I (77.8%), 5 cases of type IVA (13.9%), and 3 cases of type IVB (8.3%). Cyst excision with Roux-en-Y hepaticojejunostomy was performed in 29 (80.55%) cases. This procedure was combined with a left lateral sectionectomy, left hepatectomy, and radical cholecystectomy in 1, 2, and 1 cases, respectively. Lilly's technique was used in 2 cases, and cyst excision with hepaticoduodenostomy was performed in 1 case. Early complications were seen in 21 patients (58.3%), and late complications were seen in 5 patients (13.8%). 2 patients were found to have associated malignancies. One patient was detected to have cholangiocarcinoma in the resected liver incidentally, and another patient was diagnosed to have gall bladder cancer intraoperatively.
Conclusion:
Choledochal cysts should be considered in the differential diagnosis of adults presenting with epigastric or right hypochondrium pain or jaundice. A thorough preoperative evaluation is required. Cyst excision with Roux-en-Y hepaticojejunostomy forms the standard treatment in most cases. Long-term follow-up is essential for management of complications and early detection of malignant change.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:20Cholecystitis