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Manifestations and surgical treatment of choledochal cyst in different age group patients
1Department of Surgery, National Taiwan University Hospital, Taipei, ROC.
Insights
Early surgery for choledochal cysts is recommended. This study found older patients had higher liver enzymes, more sludge, and inflammation, suggesting timely intervention prevents complications like pancreatitis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatology
Background:
- Choledochal cysts (CCs) are congenital biliary anomalies with controversial indications for early surgical intervention in asymptomatic cases.
- Understanding age-related manifestations is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the clinical and histological manifestations of choledochal cysts across different age groups (infants, children, adults).
- To determine if early surgical intervention is warranted to prevent complications.
Main Methods:
- Retrospective analysis of 57 patients who underwent CC surgery between 1988 and 1995.
- Patients were stratified into three age groups: infants (<1 yr), children (1-16 yr), and adults (>16 yr).
- Clinical data, liver function tests, biliary parameters, and histological findings were compared across groups.
Main Results:
- Abdominal pain was the predominant symptom in children and adults, while jaundice was more common in infants.
- Elevated alanine aminotransferase levels were observed in older children and adults compared to infants.
- Increased incidence of biliary sludge/stone formation and higher bile amylase concentrations were noted in older age groups.
- Histological examination revealed more inflammatory changes in the cyst wall and gallbladder of older patients.
Conclusions:
- Early surgical intervention for choledochal cysts is recommended.
- Timely surgery can prevent significant liver injury, biliary sludge and stone formation, and pancreatitis.
Abstract:
Whether early surgery is necessary for asymptomatic choledochal cyst is still controversial. In order to evaluate the manifestations of choledochal cyst on different age group patients, we investigated 57 patients, 36 females and 21 males, who underwent surgery for choledochal cyst at National Taiwan University Hospital from July 1988 to June 1995. Of these, 93% were classified as type I according to the Alonzo-Lej or Todani classification method. Patients were divided into three groups according to their age at surgery: group I, 14 infants (< 1-yr); group II, 28 children (1-16 yr); and group III, 15 adults (> 16 yr). The most common symptom in infants was jaundice, while abdominal pain was the most frequent in children and adults. Preoperative evaluation of liver function showed that alanine aminotransferase was higher in group II (160 +/- 77 IU/L) and group III (164 +/- 75 IU/L) than group I (74 +/- 28 IU/L). A higher tendency of biliary sludge and stone formation was noticed in group III (6/15, 40%) when compared with group I (2/14, 14.3%) and group II (5/28, 17.9%). The incidence of high bile amylase concentration in the choledochal cyst was higher in groups II (16/21,76.2%) and III (9/11, 81.8%) than in group I (2/9, 22.2%). There was more inflammatory changes detected in the choledochal cyst wall and gall bladder by histologic examination in older patients (groups II and III). Therefore, an early surgery for choledochal cyst is suggested for prevention of liver injury, biliary sludge, stone formation and pancreatitis.