Fictitious pancreatitis in choledochal cyst

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Diagnostics

Background:

• Choledochal cysts classically present with abdominal pain, jaundice, and a palpable mass.
• Atypical presentations include cyst rupture, bile peritonitis, pancreatitis, and esophageal varices.

Observation:

• Three pediatric cases presented with recurrent acute pancreatitis and elevated serum amylase.
• Laparotomy revealed no pancreatic inflammation but high amylase levels within the choledochal cyst fluid.
• The cyst wall showed inflammatory reactions.

Findings:

• Elevated serum amylase in these cases was attributed to high amylase concentration within the choledochal cyst.
• These findings support the pancreatic reflux hypothesis for choledochal cyst etiology.
• Cyst excision led to asymptomatic outcomes for all three patients.

Implications:

• Hyperamylasemia should not impede surgical management of suspected choledochal cysts.
• Cyst excision is the definitive treatment, resolving cholangitis and hyperamylasemia.
• Early diagnosis and surgical intervention are crucial for pediatric choledochal cyst management.