Abstract
Background. Choledochal cysts are uncommon biliary lesions. Due to the evolution of imaging and laparoscopic surgery, we sought to describe our last 3 years experience with the presentation and management of choledochal cysts in adults. Methods. A retrospective review of a prospectively established database of adults who were managed for primary choledochal cyst disease between 2005 and 2008 was performed. Results. Between 8/2005 and 8/2008, 14 adults were managed for primary choledochal cyst disease. The average age was 41 years (range 17–86) and 79% were female. Presentations included biliary sepsis (3), pancreatitis (2), abdominal pain (3), or painless jaundice (1). Three patients had the cyst found during laparoscopic cholecystectomy, and two had an incidental finding after CT scan for an unrelated issue. The length of stay for those who had the cyst removed was 7.8 days (range 5–11). There were no operative or post-operative complications. Conclusions. Over the last 3 years 36% of our patients with choledochal cysts presented after incidental finding, either during a laparoscopic operation or after a CT scan for an unrelated problem. Increasing utilization of laparoscopy and CT scan for abdominal complaints has lead to a change in the pattern of presentation.
Highlights
All three men presented with biliary sepsis, while the women presented with either pancreatitis (2), abdominal pain (3), painless jaundice (1), incidental finding during visual inspection or cholangiogram during laparoscopic cholecystectomy (3), or incidental finding after CT scan for an unrelated issue (2) (Tables 1 and 2)
Detection and treatment of Choledochal cysts (CDCs) is an important factor in the overall lifetime occurrence of cholangiocarcinoma
The lifetime risk of CDC associated cholangiocarcinoma is as high as 26% in some studies, and importantly, the rate of occurrence increases with age [1, 8, 13,14,15]
Summary
Choledochal cysts (CDCs) are uncommon, yet well documented congenital dilations of the intra- and/or extrahepatic biliary tree that can carry significant morbidity if not recognized and treated early [1]. There are five varieties of CDCs that are classified according to their location in the biliary tree by the Todani modification of the Alonso-Lej classification [2] This disease has been described to have a higher incidence of diagnosis during the first decade of life as well as a predominance in females of 3-4:1 [3,4,5]. While confirming the need for excision of CDCs to prevent associated morbidity, this and multiple other reports have suggested that the most common presentation of this disease in adults is rarely the classically described “triad” of right upper quadrant pain, jaundice, and palpable abdominal mass. We undertook a study of our recent experience with CDCs in adults in order to determine if the evolution of medical technology has changed the presentation, management, or short term outcomes of CDC disease from what is described in reported series that span a much broader time period. We report 14 patients over 3 years that were diagnosed with CDCs at a single institution and describe the presentation, management, and outcomes of these patients
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