Choledochal cyst is not so rare in the far east Asian countries as in the western countries. Reflux of pancreatic juice to the bile duct through anomalous pancreatobiliary ductal union (APBD) is considered as one of th important etiologic
factors.
To
study the clinical characteristics of choledochal cyst in adults and the significance of APBD and reflux of pancreatic juice into bile duct in this disease, we reviewed 57 choledochal cyst cases. APBD is defined as long common channel(>1.5cm) and
we
interpreted as presence of cases. APBD is defined as long common channel(>1.5cm) and we interpreted as presence of pancreatic juice reflux if bile amylase was greater than 600 IU/dl. Ages ranged from 16 to 72 years and the fourth decade was the
most
prevalent. One third of the patients had all triad symptoms-abdominal pain, mass and jaundice. Diagnosis was made by ultrasonography and cholangiography in most of the cases, and preoperative diagnosis was made in 82%. Gallstones were associated
in
45.6% of the cases (26 cases) and biliary tract malignancy in 8.8% (5 cases). Three of the latter patients expired within 1 year after operation. Todani type I(68.4%), and IV(26.3%) are the two most common types. Long common channel was found in
65% of
the cases (11/17) and bile amylase was above 600 IU in 78.6% of the cases (22/28). Forty six patients were followed up for a median period of 6.5 years after initial operation. Among 17 patients who underwent cystojejunostomy, pancreatitis or
cholangitis developed in 3 patients and 1 case expired due to periampullary cancer 1 year after operation and 1 case developed CBD cancer and expired 10 months after a second operation. Among 21 patients who underwent cyst excision, 5 patients
suffered
from cholangitis or pancreatitis. In conclusion, choledochal cyst in adults in frequently associated with other biliary tract disease, the most significantly biliary tract malignancy. APBD seems to play an important role in the pathogenesis of
choledochal cyst, especially type Ia and IV. Excision of the cyst is the procedure of choice for the treatment because it eliminate APBD and potentials to develop malignancy or preexisting malignancy. (Korean J Gastroenterol 1994 ; 26 : 549-560)
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