DIAGNOSTICS AND TREATMENT OF CHOLEDOCHAL CYSTS IN CHILDREN

Abstract

Introduction. Cysts of the common bile duct or choledoch cysts (CC) are congenital cystic dilatation of the extrahepatic and / or intrahepatic bile ducts. The etiology is not fully clear, but it has been proven that abnormal pancreatobiliary anastomosis plays a major role in CC formation. Clinical manifestations range from prolonged jaundice in newborns to non-specific abdominal pains in older patients. Purpose. To study clinical manifestations of common bile duct cysts in children of different age, to define diagnostic criteria as well as to analyze outcomes after surgical treatment. Material and methods. In 2001-2019, 27 patients with chronic obstructive CC, aged from several days to 12 y.o., were treated in the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies of St. Petersburg. Most of them (16-59.2%) had CC of type IA by the Todani classification. Ultrasound examination and MRI cholangiography were used for diagnostics. Children with CC of type V (Caroli disease) required a specific approach to their treatment because of the combined malformations in kidneys (polycystic kidney disease); in 19 patients with CC of types I and IV the cystically altered choledoch was resected and hepaticojejunostomy was put on the loop by the P technique. Results. 19 patients were operated on. Good outcomes were in 15 cases. Underlying disease complications in the preoperative period were noted in 8 patients: pancreatitis in 5 patients, perforation of cysts with biliary peritonitis in 3 patients. In the postoperative period, 4 patients had complications: stenosis of the anastomosis in 1; portal hypertension in 1; 3 children developed cholangitis, 1 of them required surgical correction. Out of 5 patients with Caroli disease, 2 children died in the neonatal period, one because his parents refused of treatment. Two children aged 12 and 17 had liver and kidney transplantation. Conclusion. CC clinical manifestations are diverse; asymptomatic course can develop up to some age. Ultrasound and MRI cholangiography are main diagnostic tools. Resection of the cyst with hepaticojejunostomy on the loop by the P technique is a radical approach to the treatment and has good outcomes. Patients with Caroli disease require an individual approach.