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Choledochal cysts in adults

S R Jesudason1, S Govil, V Mathai

  • 1Department of General Surgery II, Christian Medical College Hospital, Vellore, India.

Annals of the Royal College of Surgeons of England
|January 10, 1998
PubMed
Summary
This summary is machine-generated.

Choledochal cysts require consideration in patients with dilated bile ducts, particularly those with persistent symptoms post-surgery. Surgical resection is effective, with a modified technique aiding complete excision and improved outcomes for choledochal cyst management.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Hepatobiliary Surgery

Background:

  • Choledochal cysts are congenital dilations of the bile duct.
  • Diagnosis can be challenging, especially in adults with prior biliary surgery.
  • Common presentations include pain, jaundice, and pancreatitis.

Purpose of the Study:

  • To discuss the clinical features and management of adult choledochal cysts.
  • To highlight diagnostic challenges and recommend diagnostic approaches.
  • To describe a modified surgical technique for improved cyst excision.

Main Methods:

  • Retrospective review of 14 adult patients with choledochal cysts.
  • Analysis of clinical presentation, cyst type (Todani I and IV), associated anomalies, and management.
  • Utilized cholangiography and hepatic iminodiacetic acid (HIDA) scans for diagnosis.
  • Surgical resection with a modified technique was performed in all cases.

Main Results:

  • 10 patients had Todani type I, and 4 had type IV cysts.
  • 10 patients presented with cystolithiasis; 6 had prior biliary surgery.
  • HIDA scan proved useful in diagnosing challenging cases post-sphincterotomy.
  • Complete cyst resection was achieved in all patients, with one postoperative mortality.

Conclusions:

  • Choledochal cyst should be considered in adults with dilated bile ducts, especially with persistent symptoms after biliary surgery.
  • HIDA scan can aid diagnosis when cholangiography is inconclusive.
  • Complete cyst resection is the recommended treatment, and a modified surgical approach facilitates easier mobilization and excision.