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Choledochal cyst in children in dakar: Diagnostic and therapeutic aspects
Ndeye Aby Ndoye1, Ibrahima Bocar Wellé2, Lissoune Cissé2
1Department of Pediatric Surgery, Albert Royer Children's Hospital; Cheikh Anta Diop University, Dakar, Senegal.
Insights
Choledochal cyst (bile duct cyst) diagnosis and management in children were studied in Dakar. Surgical intervention, primarily excision with hepatico-jejunal anastomosis, proved effective with no mortality, highlighting the importance of prompt diagnosis and treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Choledochal cyst (bile duct cyst) is a rare congenital malformation predominantly affecting female children.
- Early diagnosis and management are crucial for preventing complications such as biliary cirrhosis and malignancy.
Purpose of the Study:
- To describe the diagnostic, therapeutic, and evolutionary features of bile duct cysts in pediatric patients in Dakar.
- To evaluate the outcomes of surgical management for choledochal cysts in a West African setting.
Main Methods:
- A prospective, single-center descriptive study was conducted over three years (2016-2019) at Albert Royer Children's Hospital, Dakar.
- Ten pediatric patients diagnosed with choledochal cysts were included, with data collection encompassing clinical, biological, radiological, and therapeutic aspects.
- Imaging modalities, including ultrasound and CT scans, were utilized for diagnosis and classification according to the Todani system.
Main Results:
- Abdominal pain and vomiting were the most common presenting symptoms, with two patients exhibiting the classic triad of pain, mass, and jaundice.
- Biological cholestasis was observed in six patients, and cytolysis in five.
- The majority of cysts were classified as Todani Types 1 and 4. Surgical treatment involved total cyst excision and hepatico-jejunal anastomosis in nine patients; one underwent cyst drainage.
- Two patients experienced post-operative complications (anastomotic leak, evisceration) but achieved good outcomes after surgical repair. No mortality was recorded.
Conclusions:
- Choledochal cyst dilatation (CCD) should be suspected in neonates presenting with gastrointestinal symptoms, potentially with jaundice.
- A combination of ultrasound and CT scans is effective for diagnosing CCD and determining the appropriate Todani classification.
- Laparotomy remains a valuable surgical approach for managing choledochal cysts, particularly in resource-limited settings like Dakar.
Context:
Choledochal cyst is a rare malformation that mainly affects girls.
Aims:
The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar.
Subjects And Methods:
we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected.
Results:
Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality.
Conclusions:
The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.
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