Authors reviewed and pursued twenty nine patients of surgically treated choledochal cyst and compared the clinical features of children and adults.
There were fifteen children and fourteen adults, and the male to female ratio was 1:9. The most frequent clinical symptoms were abdominal mass and pain in children and were abdominal pain and fever I adults. The classic symptom triad of abdominal
mass,
pain and jaundice was noticed in only each one case of children and adults. In liver function tests transaminases and alkaline phosphatase were chiefly increased in children, but transaminases and bilirubin were more frequently increased in
adults.
The
most sensitive imaging diagnostic modality was hepatobiliary ultrasonogram in both children and adults, and the endoscopic retrograde cholangiopancreatogram was useful for identification of the anomalous junction of pancreaticobiliary duct in
adults.
According to the Todani's classification, twenty seven patients had type I cyst, one patient had type II, and one patient had type Via. In the operative findings none of the children had anomalous junction of pancreaticobiliary duct, and in all
but
one
case, the opening of distal common bile duct was not identified. In adults, ten of fourteen parients presented the anomalous junction of pancreaticobiliary duct. Operative procedures for children were cyst excision with hepaticojejunostomy in
thirteen
patients, cyst excision with choledochoduodenostomy in one patient, and cystojejunostomy without cyst excision in one patient. For adults, cyst excision with hepaticojejunostomy was done in eleven patients, pancreaticoduodenectomy in two patients
and
cystojejunostomy without cyst excision in one patient. Postoperatively two patients sufferred from intermittent cholangitis and one patient developed intrahepatic stones, but reoperation was not necessary. Two patients died of intracystic
carcinoma
and
carcinoma of the colon. Remaining twenty three patients were in good health.
Cyst excision with hepaticojejunostomy is recommended as a treatment of choice to eliminate the risks of variant sequele including malignancy.
|