Clinical Study and Management of Choledochal Cyst
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 8
Abstract
Introduction: Choledochal cyst is defined as an isolated or combined congenital dilatation of the extra or intrahepatic biliary tree. Choledochal cyst is not an isolated entity but rather regarded as a constellation of pathological anomalies in the hepato-pancreatico-biliary system. In children, the classical findings include a right upper quadrant abdominal mass, jaundice, and abdominal pain. In the adult, however, it is more complicated. Hence, the diagnosis is often confused with benign disease of biliary tract or pancreas. The most reliable and primary mode of investigation is the ultrasonography. This is followed by cholangiographic modalities like magnetic resonance cholangiopancreatography, particularly in adults to confirm the diagnosis, to know the associated complications, to know the probable etiology, and to delineate the exact anatomy of the cyst and intra- and extra-hepatic biliary tree for surgical management. The management depends on the type of cyst and its associated complications. Choledochal cyst excision with reconstruction through biliary-enteric Roux-en-Y anastomosis rather than cyst drainage alone has become the mainstay of the treatment for most types of choledochal cysts. Exceptions to this are the treatment of Type-III and Type-V choledochal cysts, where they were managed conservatively with stenting, sphincterotomy, and hepatectomy for liver transplant, respectively. Aim: This study aims to study the age and sex, clinical presentation, diagnostic modalities used in detection, complications, and surgical management of choledochal cyst in Osmania general hospital over the period of January 2016–November 2017. Materials and Methods: The present prospective clinical study includes 20 patients of all ages having choledochal cyst presented to the department of general surgery and surgical gastroenterology in Osmania general hospital. All the patients have undergone both medical and surgical management. The medical management includes pre-operative stenting with 8F/10F double pigtail stent to reduce the levels of jaundice and control of cholangitis before surgery. Surgical includes complete excision of cyst with Roux-en-Y hepaticojejunostomy, end-to-side anastomosis was done. The patients are observed postoperatively for complications such as wound infections, bile leak, pancreatitis, and cholangitis and the results were analyzed. Results and Conclusions: The incidence of choledochal cyst in Osmania general hospital (admission is 1:100,000) is comparable to Asian population statistics. Incidence among female:male is about 1.5:1. Mean age of incidence is 29 years. Recurrent cholangitis is the most common clinical presentation in this series. Ultrasound abdomen is the primary mode of investigation with 96% sensitivity; endoscopic retrograde cholangiopancreatography has 100% sensitivity. Type I choledochal cyst is the most common presentation; Types II and V are not encountered. Associated complication incidence in this series is 60%, comparable to western series. The incidence of malignancy is 0% in the present series against 3–8% in western series.
Authors and Affiliations
Vijaya Bhargava, Rajkumar Sade
Keywords
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