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Choledochal cyst in childhood
1Department of Paediatric Surgery, University Hospital, Lund, Sweden.
Insights
Four young girls with choledochal cysts underwent successful surgical treatment. Early ultrasonography is recommended for children with biliary tract symptoms to ensure timely diagnosis and intervention.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Choledochal cysts are congenital bile duct dilatations.
- Early diagnosis and surgical intervention are crucial for pediatric patients.
Observation:
- Four pediatric patients (girls aged 6-9) presented with abdominal pain, jaundice, and right upper quadrant tenderness.
- Ultrasonography revealed cystic dilatation of the choledochus.
- Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the diagnosis and delineated the pancreaticobiliary junction.
Findings:
- All patients underwent complete excision of the choledochal cyst and extrahepatic biliary tree.
- A Roux-en-Y hepaticojejunostomy was performed in all cases.
- Postoperative recovery was uneventful for all patients.
Implications:
- Complete excision and Roux-en-Y hepaticojejunostomy are effective treatments for pediatric choledochal cysts.
- Abdominal ultrasonography should be liberally used for children presenting with biliary tract symptoms.
- Timely diagnosis via imaging modalities like ultrasonography and ERCP is vital for favorable outcomes.
Abstract:
During a two years period, four children were operated on because of choledochal cysts. All four patients were girls aged 9, 9, 8 and 6 years at operation. The symptoms at presentation were mainly episodic abdominal pain, mild jaundice and tenderness under the right costal curvature. Ultrasonography of the biliary tract revealed a cystic dilatation of the choledochus. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the cystic dilatation and, importantly, delineated the junction of the pancreatic duct. The surgical procedure in all four patients consisted of complete excision of the choledochal cyst and extrahepatic biliary tree combined with a Roux-en-Y hepaticojejunostomy. The postoperative course of all patients was uneventful. Ultrasonography of the abdomen should be performed liberally in case of biliary tract symptoms in children.