Choledochal cyst, or cystic dilatation of other portion of the biliary tree, occur uncommonly. This abnormality of bile duct is more common in Orient, especially in Japan than other countries.
Recently, the frequency of reported cases has increased due to improvement of diagnostic methods such as ultrasonogram and abdominal CT scanning. Authors reviewed 22 cases of choledochal cyst treated surgically at the Dept. of General Surgery,
School of
Medicine, Kyung Hee University, during the period of January 1980 to February 1991.
@ES The results were as follows:
@EN 1) The ratio of female to male was 4.5 : 1 which revealed predominance in female and age ranged from 21 months to 74 years old.
2) The ratio of adult to children was 2 1:1 at the time of treatment.
3) The main clinical symptoms and signs were, in order of frequency, abdominal pain(81.8%), jaundice(54.5%), nausea and vomiting(54.5%), palpable abdominal mass(31.8%), the classical symtom triad of choledochal cyst was present in 3
cases(13.6%).
4) Alkaline phosphatase was elevated at 21 cases(95.5%) and hyperbilirubinemia and increased transaminase was observed in 54.5% of the patient respectively.
5) Preoperative diagnostic study was performed using ultrasonography(90.9%), abdominal CT (54.5%), hepatobiliary scan(40.9%) in order of frequency and the most commonly used diagnostic approach was abdominal sonogram followed by abdominal
CT(50.0%).
The diagnostic accuracy of ultrasonography was 85%.
6) Preoperative diagnosis was choledchal cyst in 19 cases(86.3%) and liver abscess with acute cholangitis in 2 cases(9.2%) and pancreatic cyst with cholelithiasis in 1 cases(4.5%).
7) The most common associated disease was acute cholangitis(18.2%).
8) According to the Todani's classification, the most common type was type I(72.8%) and type IV-A(18.2%), type II(4.5%), type III(4.5%), in order of frequency.
9) The most commonly used surgical procedure was cyst excision and Roux-en-Y hepaticojejunostomy(with or without submucosal dissection) in 16 cases(72.8%) and non-excision(bypass only) procedure were performed in 4 cases(18.2%).
10) The postoperative complications were wound infection in 5 cases, bile leakage in 4 cases, postoperative pancreatitis in 3 cases and pneumonia in 2 cases, pleural effusion, subphrenic abscess, pancreatic juice leakage were 1 case
respectively.
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