International Journal of Anatomy Radiology and Surgery (Oct 2016)
Surgical Management of Choledochal Cysts in Children- Our Experience in a District Level Teaching Hospital
Abstract
Introduction: Choledochal cyst is a rare congenital dilatation of the bile ducts. It occurs frequently in females. Its incidence is more in Asian population particularly in Japan. Aim: To study the clinical presentation, diagnosis, management and results of 10 patients of choledochal cyst treated in a district level teaching hospital. Materials and Methods: It is a retrospective study about the clinical presentation, management and results of treatment of 10 cases of choledochal cysts managed over 7 years during April 2009 to March 2016. Medical records of the children admitted with choledochal cysts during the study period in MGM Hospital Warangal, India were studied. Results: The age of the patients ranged from 25 days-12 years. Two patients were 1 year or less in age (infantile group) and 8 patients were more than 1 year old (classical pediatric group). Children less than 1 year presented with jaundice (n=2), hepatomegaly (n=2) and clay colored stools (n=2) whereas, those above 1 year presented with pain (n=8) jaundice (n=2) and palpable mass in right hypochondrium (n=2). Ultrasonography diagnosed/ suggested choledochal cyst in all cases, however, CT-scan (n=5) and MRCP (n=5) also contributed to the diagnosis. Nine patients had type I choledochal cyst and 1 patient had type IV variety having intrahepatic and extrahepatic dilatation. Operative management included primary total excision of cyst and Roux-en-Y hepaticojejunostomy (n=7), Lilly’s modification of submucosal resection with hepaticojejunostomy (n=2) and total cyst excision with hepaticoduodenostomy (n=1). Two patients had wound infection which needed secondary suturing. There was one post operative death due to burst abdomen and sepsis. Conclusion: Choledochal cyst should be ruled out while evaluating neonates and infants with obstructive jaundice and older children with recurrent abdominal pain. Primary excision of the cyst with hepaticojejunostomy provides satisfactory results in infants and children.
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