Management of adult choledochal cysts – a 15-year experience

Jesudason, S. R. Banerjee; Jesudason, Mark Ranjan; Mukha, Rajiv Paul; Vyas, Frederick L; Govil, Sanjay; Muthusami, John C.

doi:10.1080/13651820500466715

Cited by 23 publications

(24 citation statements)

References 25 publications

(40 reference statements)

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“…[16][17][18][19][20][21][22][23] (Table 6), though larger series from other parts of World have shown a weaker link. [13][14][15] The incidence of APBDJ has been found to be low in major Indian series as well. 15,[24][25][26][27][28][29] In the present study, APBDJ was present 20% of patients, which is consistent with previous findings in Indian patients ( Table 7).…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] The incidence of APBDJ has been found to be low in major Indian series as well. 15,[24][25][26][27][28][29] In the present study, APBDJ was present 20% of patients, which is consistent with previous findings in Indian patients ( Table 7). The APBDJ is a known risk factor for biliary tract malignancy.The chronic pancreaticobiliary reflux incites inflammation in the gallbladder and bile duct mucosa, thus leading to dysplasia and malignant changes.…”

Section: Discussionmentioning

confidence: 99%

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A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Kumar¹

2018

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Background: Aim of the study was to analyze the clinicopathological profile and long-term operative outcomes of patients with choledochal cysts (CDC) undergoing cyst excision. Methods: Clinical data of 73 adult CDC patients managed at a single tertiary care center between January 2010 and December 2016 were retrospectively analyzed. Patients who had undergone complete cyst excision and with a minimum follow-up of 12 months were included for long-term outcome analysis. Results: The male female ratio was approximately 1:3 and the median age was 35 years (range, 12-65 years). Type I CDC was the most common cyst type in this series (n=49/73, 67.1%). Abdominal pain was the commonest presenting symptom followed by jaundice, fever and palpable lump. Coexisting gallbladder carcinoma was encountered in 4/73 (5.48%) patients while two patients had secondary biliary cirrhosis with portal hypertension. Complete cyst excision was performed in 65 out of 73(89.0%) patients. Patients undergoing complete cyst excision were followed-up for a median duration of 29.5 months (range, 12-70 months). One case of hepaticojejunostomy stricture and two cases of post-operative incisional hernia were reported. No new case of cholangiocarcinoma was reported in any of our patients. Conclusion: Adulthood CDC are associated with an increased incidence of complications like recurrent cholangitis, pancreatitis and cyst perforation. The lesser association of biliary tract malignancy in Indian population may possibly be linked to a lower incidence of abnormal pancreaticobiliary duct junction. Complete cyst excision with hepaticojejunostomy remains the standard treatment both to relieve the symptoms and to minimize the risk of malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Kumar¹

2018

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“…43,124,164 Overall, CC resection has an excellent prognosis, with an 89% event-free rate and 5-year overall survival rates well over 90%. 50,165,166 However, the risk of biliary malignancy remains elevated even more than 15 years after CC excision, and CC-associated biliary malignancy is associated with extremely unfavorable outcomes, with a reported median survival of 6 to 21 months. 10,52,29,63,64,72,79,167 Therefore, long-term surveillance is warranted, particularly in instances with persistent intrahepatic biliary dilatation.…”

Section: Outcomes and Prognosismentioning

confidence: 99%

Choledochal Cysts: Presentation, Clinical Differentiation, and Management

Soares

Arnaoutakis

Kamel

et al. 2014

Journal of the American College of Surgeons

241

285

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“…The clinical presentation is more of abdominal mass and jaundice in the infants, and more of abdominal mass, jaundice and abdominal pain in older children [35]. The only infant in our case had the compliant of abdominal mass and jaundice, whereas the other two children had the classical triad of abdominal mass, intermittent jaundice and abdominal pain commonly seen in older children with choledochal cyst.…”

Section: Diagnostic Evaluationmentioning

confidence: 60%

“…Abdomino-pelvic ultrasound scan revealed a huge well-circumscribed intra-abdominal cystic lesion with coarse internal echoes within it, located posteroinferior to the liver and extending from anterior abdominal wall to the spine, measuring about 10.03 cm × 9.26 cm × 6.98 cm. 35-50 g/L). The patient was nutritionally rehabilitated, resuscitated and prepared for laparotomy.…”

Section: Casementioning

confidence: 99%

Choledochal Cyst: A Report of 3 Cases and a Review of its Treatment and Outcome

Wabada¹,

Abubukar²,

Bwala³

et al. 2017

Surgery Curr Res

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Choledochal cyst (CC) is not common in Africans. Unlike biliary atresia, this condition commonly presents in late infancy and early childhood, and occasionally also in adults. Typical pattern of presentation is with abdominal mass, abdominal pain and seldom intermittent jaundice. These conventional presentations can be sometimes heralded by chollangitis, malnutrition, and failure to thrive in some category of patients with delayed presentation.Case 1 was a 2-month-old girl who developed fluctuating jaundice on the 5th day of life, associated steatorrhoea, and yellowish discolouration of the urine and occasional bilious vomiting. Ten days before presentation she developed low grade fever, excessive crying and refused to suck. She was resuscitated and hepaticoduodenostomy was performed between the second part of the duodenum and the stump of the common hepatic duct.Case 2 was a 4-year-old girl who presented with a 5-month history of fluctuating jaundice associated abdominal pain, epigastric swelling, weight loss and occasional non-bilious vomiting. A retrocolic end-to-side Roux-en-Y hepaticodochojejunostomy was performed after nutritional rehabilitation.Case 3 was a 5-year old girl with intermittent jaundiced noticed 2-months before presentation, right hypochondrial swelling and colicky right sided abdominal pain almost of same duration. Intraoperatively features of likely cirrhotic liver changes in addition to a huge choledochal cyst were seen. An end to side Roux-en-Y hepaticochojejunostomy was established to the stump of the common hepatic duct.All the cases did well after surgery and were discharged. Regardless of the clinical features, and the morphological changes in the liver, excision of the cyst with establishment of free flowing hepatoenterostomy should be done. Patients' general outlook can be immediately improved after excision of the cyst with hepatoenterostomy. Because the complications of caused by bile flow obstruction are remarkably reduced or rather eliminated. We hereby report three cases we recently managed in our centre with complications of choledochal cyst which improved after excision of the cyst with creation of hepatoenterostomy.

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Management of adult choledochal cysts – a 15-year experience

Cited by 23 publications

References 25 publications

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

A Single-Center Experience with 73 Patients of Adult Choledochal Cyst: An Indian Perspective

Choledochal Cysts: Presentation, Clinical Differentiation, and Management

Choledochal Cyst: A Report of 3 Cases and a Review of its Treatment and Outcome

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