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Published on: February 28, 2025
Choledochal Cysts in Children: A Single-Center Study in South India
Venkat Kumar Raju Cherukuri1, Shilpa Radhakrishnan2, R Bhanu Vikraman Pillai3
1Pediatrics, Amrita Institute of Medical Sciences and Research Center, Kochi, IND.
Insights
This study analyzed pediatric choledochal cysts in South India, finding Type I cysts most common and abdominal pain the primary symptom. Early diagnosis and surgical intervention are crucial for improving outcomes in children with these rare biliary tract anomalies.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Congenital Anomalies
Background:
- Choledochal cysts are rare congenital biliary tract anomalies with limited pediatric data, especially in South India.
- Understanding their clinical spectrum, management, and outcomes is vital for improving pediatric care.
Purpose of the Study:
- To analyze the clinical presentation, types, comorbidities, management, and long-term outcomes of pediatric choledochal cysts.
- To provide insights into the disease profile in South India over a 20-year period.
Main Methods:
- Retrospective audit of hospital records from 147 pediatric patients.
- Data collected included clinical presentation, radiological findings, laboratory investigations, management, and outcomes.
Main Results:
- Female predominance (M:F ratio 1:2.4) with a mean age of 3.4 months at presentation.
- Type I cysts were most frequent (63%), followed by Type IV (31%). Abdominal pain was the most common symptom (58%).
- Pancreatitis occurred in 20% of patients, and 12% had renal anomalies. Surgical intervention was performed in 75%.
Conclusions:
- Pediatric choledochal cysts in South India present with specific characteristics, including a high prevalence of Type I cysts and frequent abdominal pain.
- Early diagnosis and surgical intervention are recommended to mitigate long-term complications like chronic liver disease and portal hypertension.
- Further multicenter studies are necessary to enhance understanding of disease progression and optimize patient outcomes.
Abstract:
Objectives Choledochal cysts are rare congenital anomalies of the biliary tract with limited data on their clinical spectrum and outcomes in pediatric populations, particularly in South India. This study aimed to analyze the clinical presentation, types, associated comorbidities, management, and long-term outcomes of choledochal cysts in children over a 20-year period at a single tertiary care center. Methods This retrospective audit of hospital records study was conducted at the Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India. Data from 147 pediatric patients with choledochal cysts were analyzed, including clinical presentation, radiological findings, laboratory investigations, management, and outcomes. Results Among 147 patients, 103 were female (M:F ratio = 1:2.4). The mean age of the patients at presentation was 3.4 months. Abdominal pain (58%, n=85) was the most common symptom, while the classic triad of pain, jaundice, and palpable mass was rare (4%, n=6). Type I cysts (63%, n = 93) were the most frequent, followed by type IV (31%, n = 46) and Caroli's disease (5.4%, n=8). Anomalous pancreaticobiliary junction (APBJ) was seen in 14% (n=21) of patients, of whom 43% had pancreatitis. Overall, pancreatitis occurred in 20% of patients (n=29), and renal anomalies were noted in 12% (n=18). Surgical intervention was performed in 75% (n=110) of the patients, with a mean age at surgery of 4.1 years. Histopathology revealed metaplastic changes in 3% of the cases (n=3). Long-term complications included chronic liver disease (7%, n=11) and portal hypertension (4%, n=6). Conclusion This study highlights the clinical profile of pediatric choledochal cysts in South India, emphasizing early diagnosis and surgical intervention, which may reduce complications and improve outcomes. Multicenter studies are needed to improve understanding of disease progression and outcomes.
