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Choledochal cysts: a nine-year review
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, Republic of China.
Insights
This study reviewed 24 pediatric choledochal cyst cases, finding ultrasonography effective for diagnosis. Cyst excision with Roux-en-Y hepaticojejunostomy is the preferred treatment, with no malignancy detected.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Choledochal cysts are congenital biliary tract abnormalities.
- Diagnosis and management in pediatric populations require specific considerations.
Purpose of the Study:
- To review clinical presentations, diagnostic methods, and treatment outcomes for pediatric choledochal cysts.
- To evaluate the efficacy of surgical intervention and identify pathological findings.
Main Methods:
- Retrospective review of hospital records for 24 pediatric patients diagnosed with choledochal cysts.
- Analysis of presenting symptoms, diagnostic imaging (ultrasonography), surgical procedures, and pathological findings.
- Inclusion of liver biopsy results for a subset of patients.
Main Results:
- The study included 24 infants and children aged 1 day to 17 years.
- Common presentations included abdominal pain, palpable abdominal mass, and jaundice.
- Type I choledochal cysts (22 patients) were treated with surgery, while Type V (2 patients) were not.
- Ultrasonography proved to be a rapid and accurate diagnostic tool.
- Cyst excision with Roux-en-Y hepaticojejunostomy was the primary surgical approach.
- Chronic cholecystitis was the most frequent pathological finding.
- Liver biopsies revealed biliary cirrhosis (4 patients) and portal fibrosis (1 patient).
- No evidence of malignancy was found in any patient.
Conclusions:
- Ultrasonography is a valuable tool for the initial diagnosis of choledochal cysts in children.
- Surgical management, specifically cyst excision with Roux-en-Y hepaticojejunostomy, is effective for Type I choledochal cysts.
- Long-term follow-up is necessary to monitor for potential complications, although malignancy was not observed in this cohort.
Abstract:
Hospital records of 24 Chinese infants and children (7 males and 17 females) with choledochal cysts were reviewed. The patients were aged 1 day to 17 years. Abdominal pain, palpable abdominal mass and jaundice, either alone or in combination, accounted for most of the initial presentations. Twenty-two patients were classified as type I with surgery, while the other two patients were type V without surgery. Ultrasonography is a rapid and accurate diagnostic method in the initial evaluation. Cyst excision with Roux-en-Y hepaticojejunostomy was the treatment of choice in this series. Chronic cholecystitis with or without inflammation of choledochal cyst was the most common pathological finding. Five patients underwent liver biopsies, showing four biliary cirrhosis and one portal fibrosis. So far, there is no evidence of malignancy in any patient.