Korean J Hepatobiliary Pancreat Surg.  2011 Aug;15(3):157-163. 10.14701/kjhbps.2011.15.3.157.

Clinical comparison of choledochal cystsbetween children and adults

• Jang SM
• Lee BS
• Kim KK
• Lee JN
• Koo YS
• Kim YS
• Kim HY
• Park YH

• KMID: 2130987
• DOI: http://doi.org/10.14701/kjhbps.2011.15.3.157

Abstract

BACKGROUNDS/AIMS
Choledochal cyst of the bile duct is characterized by cystic dilatation of the intra- or extrahepatic bile ducts. It is a relatively uncommon disease and there is still much controversy regarding its etiology as being congenital or acquired.
METHODS
The medical records of 60 patients who underwent surgical treatments for choledochal cyst between April 1995 and April 2009 at the Gachon University Gil Hospital were reviewed retrospectively. To compare the clinical characteristics, patients under 19 years of age were grouped into children and the others were grouped into adults.
RESULTS
Of the overall 60 patients, 24 were grouped into children and 36 were grouped into adults. Female predominance was common in both groups (M : F=1 : 6.5). The most common clinical symptom was abdominal pain (73.3%) in both groups. Children had remarkable jaundice (33.3% vs. 0%) and gastrointestinal symptoms including nausea and vomiting. Fever and chills were more common in children because of the associated complications of cholangitis. According to the Todani classification, type I was the most common form of choledochal cyst in both groups, and type IVa was significantly more common in children than adults (45.3% vs. 16.7%). Thirty patients (50%) had anomalous pancreaticobiliary ductal union which was confirmed by preoperative imaging studies or intraoperative cholangiography. All patients except for one child underwent cyst excision with hepaticojejunostomy.
CONCLUSIONS
There was no significant difference in the clinical characteristics of choledochal cysts between children and adults. However, combined diseases especially bile duct malignancy were common in aged patients, early detection and more aggressive surgery is necessary for patients with choledochal cysts.

Keyword

Choledochal cyst; Children; Adults; Malignancy

MeSH Terms

Abdominal Pain
Adult
Aged
Bile Ducts
Bile Ducts, Extrahepatic
Child
Chills
Cholangiography
Cholangitis
Choledochal Cyst
Dilatation
Female
Fever
Humans
Jaundice
Medical Records
Nausea
Retrospective Studies
Vomiting

Reference

1. Gertler JP, Cahow CE. Choledochal cyst in the adult. J Clin Gastroenterol. 1988; 10:315–319. PMID: 2980768.

2. Babbitt DP, Starshak RJ, Clemett AR. Choledochal cyst: a concept of etiology. Am J Roentgenol Radium Ther Nucl Med. 1973; 119:57–62.

3. Nagata E, Sakai K, Kinoshita H, Hirohashi K. Choledochal cyst: complications of anomalous connection between the choledochus and pancreatic duct and carcinoma of the biliary tract. World J Surg. 1986; 10:102–110. PMID: 3962321.

4. Suh SJ, Choi SO, Park WH. Clinical analysis of choledochal cyst in childhood. J Korean Surg Soc. 2003; 65:564–571.

5. Moon HJ, Choi DI, Heo JS, Joh JW, Kim YI, Choi SH. Asymptomatic adult choledochal cyst. J Korean Surg Soc. 2004; 66:226–230.

6. Nam YH, Jung JH, Song YT. Clinical analysis of choledochal cysts in children. J Korean Surg Soc. 2008; 75:328–335.

7. Komi N, Takehara H, Kunitomo K, Miyoshi Y, Yagi T. Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? J Pediatr Surg. 1992; 27:728–731. PMID: 1306647.

8. Guelrud M, Morera C, Rodriquez M, Prados J, Jaen D. Normal and anomalous pancreaticobiliary union in children and adolescents. Gastrointestinal Endoscopy. 1999; 50:189–193. PMID: 10425411.

9. Lee JS, Lim TS, Kim YS. A clinical analysis of choledochal cyst. J Korean Surg Soc. 1990; 38:459–466.

10. O'Neill JA Jr, Templeton JM Jr, Schnaufer L, Bishop HC, Ziegler MM, Ross AJ 3rd. Recent experience with choledochal cyst. Ann Surg. 1987; 205:533–540. PMID: 3555362.

11. Lee YC, Kim JS, Kim JJ, et al. Characteristics of adult-onset choledochal cyst. J Korean Surg Soc. 2001; 61:81–85.

12. Robertson JF, Raine PA. Choledochal cyst: a 33-year review. Br J Surg. 1988; 75:799–801. PMID: 3167534.

13. Mori K, Nagakawa T, Ohta T, et al. Pancreatitis and anomalous union of the pancreaticobiliary ductal system in childhood. J Pediatr Surg. 1993; 28:67–71. PMID: 7679143.

14. Kim MJ, Han SJ, Yoon CS, et al. Using MR cholangiopancreatography to reveal anomalous pancreaticobiliary ductal union in infants and children with choledochal cysts. AJR Am J Roentgenol. 2002; 179:209–214. PMID: 12076938.

15. Nagorney DM, McIlrath DC, Adson MA. Choledochal cysts in adults: clinical management. Surgery. 1984; 96:656–663. PMID: 6091285.

16. Ono J, Sakoda K, Akita H. Surgical aspect ot cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults. Ann Surg. 1982; 195:203–208. PMID: 7055397.

17. Takiff H, Stone M, Fonkalsrud EW. Choledochal cysts: results of primary surgery and need for reoperation in young patients. Am J Surg. 1985; 150:141–146. PMID: 4014565.

18. Ishibashi T, Kasahara K, Yasuda Y, Nagai H, Makino S, Kanazawa K. Malignant change in the biliary tract after excision of choledochal cyst. Br J Surg. 1997; 84:1687–1691. PMID: 9448616.

19. Todani T, Tabuchi K, Watanabe Y, Kobayashi T. Carcinoma arising in the wall of congenital bile duct cysts. Cancer. 1979; 44:1134–1141. PMID: 383269.

20. Fujisaki S, Akiyama T, Miyake H, et al. A case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst. Hepatogastroenterology. 1999; 46:1655–1659. PMID: 10430315.