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Choledochal cyst in infancy and childhood. Analysis of 16 cases
Insights
Early diagnosis of choledochal cysts in children is crucial. A combination of imaging techniques, including ultrasound and scintiscanning, aids in accurate pre-operative diagnosis, leading to timely surgical intervention.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Choledochal cysts are congenital biliary tract malformations requiring early diagnosis and surgical management.
- Accurate pre-operative diagnosis is essential for effective treatment planning in pediatric patients.
Observation:
- Ultrasonic echogram identified cystic masses in all examined patients.
- Contrast studies revealed characteristic duodenal displacement in 9 of 14 patients.
- Hepatobiliary scintiscanning confirmed choledochal cysts in 88% of cases, while cholangiography was positive in 75%.
Findings:
- Diagnosis was achieved pre-operatively in 14 out of 16 pediatric patients using a multimodal diagnostic approach.
- Common presenting symptoms included obstructive jaundice, acholic stools, vomiting, and abdominal mass.
- Surgical management involved primary cyst excision followed by Roux-en-Y hepaticojejunostomy, with an uneventful postoperative course in 14 patients.
Implications:
- Multimodal diagnostic imaging significantly improves the pre-operative detection rate of choledochal cysts in infants and children.
- Timely surgical intervention, including cyst excision and reconstruction, is associated with favorable outcomes, though complications like cholangitis and hepatic failure can occur.
Abstract:
Choledochal cyst was diagnosed before operation in 14 out of 16 infants and children by means of a combination of diagnostic tests. Ultrasonic echogram showed a cystic mass in all 11 patients examined. The characteristic displacement of the duodenum was noted in 9 of 14 patients by contrast studies of the upper gastrointestinal tract, and hepatobiliary scintiscanning confirmed choledochal cyst in 7 of 8 patients (88%). A cyst was shown by oral or intravenous cholangiography in 3 of 4 patients. Onset of symptoms occurred from 7 days of age to 9-5 years; in 10 patients onset occurred under 12 months of age, in 3 from 13 to 24 months, and in the remaining 3 from 2 to 9-5 years. The first symptoms were jaundice, vomiting, acholic stools, and poor sucking. Obstructive jaundice and acholic stools were found in more than 80% of the patients, and abdominal mass in 60%. Vomiting occurred in 50% of the patients, one-third of whom showed failure to thrive, and 70% of patients over the age of 1-5 years had abdominal pain. About half of the patients had a mild to moderate degree of fever. In all patients primary excision of the cyst was followed by hepaticojejunostomy in Roux-en-Y fashion. The postoperative course was uneventful in 14 patients; 2 patients died, one from ascending cholangitis and one from hepatic failure.