Choledochal cysts in adults

Hewitt, Peter; Krige, J. E. J.; Bornman, Philippus C.; Terblanche, J.

doi:10.1002/bjs.1800820333

Cited by 83 publications

(52 citation statements)

References 17 publications

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“…About half the patients are initially thought to have symptomatic gallstones or acute cholecystitis, and as many as 10-50 per cent have undergone cholecystectomy or other surgical exploration before diagnosis 5,7,12 -14,16 -18 . Jaundice is a less frequent feature in adults (reported in 10-55 per cent) 3,7,10 -14,16 , whereas cholecystitis, cholangitis and pancreatitis tend to occur at a somewhat higher rate (20-60 per cent) than in children 3,10,12,14 . A palpable abdominal mass is rarely appreciated at clinical examination in adults.…”

Section: Presentation and Diagnosismentioning

confidence: 89%

Bile duct cysts in adults

Søreide

Kørner

Havnen

et al. 2004

British Journal of Surgery

175

191

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An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en-Y hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade.

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Section: Presentation and Diagnosismentioning

confidence: 89%

Bile duct cysts in adults

Søreide

Kørner

Havnen

et al. 2004

British Journal of Surgery

175

191

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“…However, the overall finding of 14% (non intrahepatic) cholangiocarcinoma is comparable with most recent series (Table 5). 2,13,[20][21][22][23][24][25][26][27] The concept of treatment of extrahepatic choledochal cysts has changed in the past 20 years because of a persistent high risk of malignancy after drainage procedures. 23,27 In addition, a high rate of benign complications, mainly anastomotic strictures, of internal drainage procedures has been reported.…”

Section: Discussionmentioning

confidence: 99%

Choledochal cysts: Age of presentation, symptoms, and late complications related to Todani's classification

Vries

Aronson

et al. 2002

Journal of Pediatric Surgery

197

167

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“…Although the classical clinical triad of abdominal pain, jaundice and right hypochondriac mass has been reported in children, most patients (71 cases) described here had symptoms that were chronic and intermittent, often resulting in delayed diagnosis [9] . Furthermore, secondary hepatobiliary disease in adults may obscure the primary problem and compound the complexities of subsequent surgery [10][11][12][13] . Twenty-three patients with intra-or extra hepatic stones were found in this series, it deserved attention.…”

Section: Discussion Diagnosismentioning

confidence: 99%

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

Li-ming

Peng²,

Meng³

et al. 2001

WJG

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AIM To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years .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 3 9 p a t i e n t s . B e f o r e 1 9 8 5 t h e d i a g n o s i s a n d 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.

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Choledochal cysts in adults

Cited by 83 publications

References 17 publications

Bile duct cysts in adults

Bile duct cysts in adults

Choledochal cysts: Age of presentation, symptoms, and late complications related to Todani's classification

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

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