Brief Reports
Copyright ©The Author(s) 2001. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 15, 2001; 7(5): 732-734
Published online Oct 15, 2001. doi: 10.3748/wjg.v7.i5.732
Diagnosis and treatment of congenital choledochal cyst: 20 years′ experience in China
Liu-Bin Shi, Shu-You Peng, Xing-Kai Meng, Cheng-Hong Peng, Ying-Bin Liu, Xiao-Peng Chen, Zhen-Ling Ji, De-Tong Yang, Huai-Ren Chen
Liu-Bin Shi, Shu-You Peng, Xing-Kai Meng, Cheng-Hong Peng, Ying-Bin Liu, Xiao-Peng Chen, Department of Surgery, The Second Affiliated hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
Zhen-Ling Ji, De-Tong Yang, Huai-Ren Chen Department of Surgery, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Liu-Bin Shi, Department of Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China. slb5327694@sohu.com
Telephone: +86-571-87230541
Received: March 20, 2001
Revised: May 6, 2001
Accepted: May 25, 2001
Published online: October 15, 2001
Abstract

AIM: To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000).

METHODS: The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively.

RESULTS: Abdominal pain, jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures. In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality.

CONCLUSION: The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly. CT and ERCP were of great help in the classification of the disease. Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli’s disease) with frequently recurrent cholangitis.

Keywords: choledochal cyst/surgery; choledochal cyst/radiography; choledochal cyst/diagnosis; biliary tract/abnormalities; choledochal cyst/therapy; Caroli’s disease/diagnosis; Caroli’s/surgery