Ann Surg Treat Res.  2021 Nov;101(5):306-313. 10.4174/astr.2021.101.5.306.

Clinical comparison between the presence and absence of protein plugs in pediatric choledochal cysts: experience in 390 patients over 30 years in a single center

• Oh C
• Cheun JH
• Kim HY

• KMID: 2521853
• DOI: http://doi.org/10.4174/astr.2021.101.5.306

Abstract

Purpose
The incidence of choledochal cyst (CC) with protein plugs is between 15.5%–40.4%. However, studies on CCs with protein plugs in children are limited. We aimed to analyze the clinical features, surgical findings, and complications of pediatric CCs with and without protein plugs.
Methods
We retrospectively analyzed 390 patients who underwent surgery for CCs between January 1987 and September 2017. The patients were divided into 2 groups: groups A (CC with protein plugs) and B (CC without protein plugs). The presence of protein plugs was evaluated using preoperative images or identified during surgery.
Results
One hundred forty-two (36.4%) patients had protein plugs in the pancreaticobiliary duct. The most common initial clinical presentation was abdominal pain, and its incidence was significantly higher in group A (66.2%) than in group B (54.8%) (P = 0.032). The incidence of accompanying pancreatitis was also significantly higher in group A (37.3% vs. 27.0%) (P = 0.040). Anomalous pancreaticobiliary ductal union (APBDU) was found in 261 patients (66.9%) and its incidence was significantly higher in group A (74.6% vs. 62.5%) (P = 0.014). Most protein plugs were found in the cyst (88.0%) and common channel (31.7%). The incidence of early complications was higher in group A; conversely, that of late complications did not differ.
Conclusion
Approximately 36.4% of the pediatric CC patients were accompanied by protein plugs. Abdominal pain, pancreatitis, and APBDU were more commonly observed among those with protein plugs than among those without; longterm complications did not differ between them.

Keyword

Child; Choledochal cyst; Pediatrics; Protein plug

Figure

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  Fig. 1 Protein plug in the pancreaticobiliary duct. (A) Operative cholangiographic image of a 13-year-old girl showing multiple protein plugs (arrows) in the left intrahepatic duct, common hepatic duct, and distal common bile duct. (B) T2-weighted magnetic resonance cholangiopancreatography (MRCP) image of a 22-month-old boy showing filling defects (arrow) in the distal common bile duct. (C) T2-weighted MRCP image of an 8-year-old girl showing multiple filling defects (arrows) in the common channel.

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