Abstract

Aim: The aim of this study was to assess the clinical presentation of the choledochal cyst, in relation with its histopathology and the intraoperative findings as well as its evolution after surgery. 10 cases of cystic dilatation of the biliar duct extra and/or intrahepatic are analyzed.

Material and Methods: In 1 case the diagnosis was prenatal and in the remaining 9 cases, the variables such as age, sex, symptoms, liver histology, etc were analyzed retrospectively. The evolution of the patients after surgery was done. Of the 10 cases analyzed 5 (% 50) were cystic dilatations from which had early clinic presentation (before 1 years) (infantil group). Other cases were assesed as the classical group.

Results: The type of choledocal cysts: type 1 (n:6), type 4 (n:3) and type V (n:1) were detected. Mean age and male to female ratio was 3 years and 2/3. Major presenting symptoms were jaundice (n: 5), abdominal pain (n:4) and convulsion (n:1). From the analyzed symptoms, in relation with the age only the pain and the jaundice showed significant differences, being the pain most frequent in later presentation and the jaundice in the early form. Primary cyst excision and biliary Roux-en-Y reconstruction was the treatment of choice in eight cases. In 1 case, choledocoduodenostomy was performed in the outsite hospital, but the case was reconverted primary cyst excision and Rouxen-Y hepaticojejunostomy because of permanent clinical findings. In one case which is type 5, was medically treated. Cyst size was varied from 1 cm to 10 cm. The total complication rate was determined as zero in this series.

Conclussion: Primary cyst excision and Roux-en-Y hepaticojejunostomy is the treatment of choice. Regular long-term review of these patients is mandatory in the surveillance of sub-clinic cholangitis and the risk of possible long-term malignance of this entity.