Clinical Analysis of Choledochal Cyst in Childhood

Suh, Soo Jin; Choi, Soon Ok; Park, Woo Hyun

Abstract

PURPOSE
The aim of this study was to evaluate the clinical findings of choledochal cyst including the symptoms and signs, the cyst types, anomalous pancreaticobiliary duct union (APBDU), and complications according to the age group in children. METHODS: Fifty-five choledochal cyst cases treated with cyst excision and Roux-en-Y hepaticojejunostomy at the Division of Pediatric Surgery, Keimyung University Dongsan Medical Center from 1986 to 2002, were analyzed retrospectively after subdividing the cases into 5 age groups: newborn (NB), infancy, early childhood, late childhood, and adolescent. RESULTS: The age ranged from 9 days to 13.5 years (mean age: 4.4 years). The most common age group was early childhood (38.2%). Females were predominate in all age groups (overall male: female ratio 1: 3). Abdominal pain (62%) and jaundice (42%) were the two most common symptoms but abdominal pain was more common in patients above 2 years of age and the jaundice was more common in NB and infancy. The types of cyst were Todani type I (42%) and IVa (58%). There was no Type II, III, IVb and V cases. Type I is more common in NB and infancy but type IV is more common after 2 years. The APBDU was identified in 27 patients (49%). A high level of amylase in the bile and blood was observed in 25 and 15 patients respectively but there was no correlation to the type of APBDU and dilation of the common channel. There was no surgical mortality and there was no cholangitis or cancer formation in the follow-up. CONCLUSION: The clinical findings of choledochal cyst differ according to the age group. Anyone with jaundice in NB and infancy or anyone with nonspecific abdominal pain and pancreatitis after 2 years should be sreened for choledochal cyst. As the frequency of dilatation of the intrahepatic ducts and common channel increases with age, older children in particular should be followed cautiously.