Management of Complicated Choledochal Cyst in Children: Ultrasound-Guided Percutaneous External Drainage and Subsequent Definitive Operation

Abstract

Objective The purpose of this study was to retrospectively analyze the outcomes of the combination of ultrasound-guided percutaneous external drainage (US-PED) and subsequent definitive operation to manage complicated choledochal cyst in children. Methods This study included 6 children with choledochal cyst who underwent initial US-PED and subsequent cyst excision with Roux-en-Y hepaticojejunostomy between January 2021 and September 2022. Patient characteristics, laboratory findings, imaging data, treatment details, and postoperative outcomes were evaluated. Results Mean age at presentation was 2.7 ± 2.2 (0.5–6.2) years, and 2 patients (2/6) were boys. Four patients (4/6) had a giant choledochal cyst with the widest diameter of ≥ 10 cm and underwent ultrasound-guided percutaneous biliary drainage on admission or after conservative treatments. The other 2 patients (2/6) underwent ultrasound-guided percutaneous transhepatic cholangial drainage and percutaneous transhepatic gallbladder drainage due to coagulopathy, respectively. Five patients (5/6) recovered well after US-PED and underwent the definitive operation, whereas 1 patient (1/6) had liver fibrosis confirmed by Fibroscan and ultimately underwent liver transplantation 2 months after US-PED. The mean time from US-PED to the definitive operation was 12 ± 9 (3–21) days. The average length of hospital stay was 24 ± 9 (16–31) days. No related complications of US-PED occurred during hospitalization. At 10.2 ± 6.8 (1.0–18.0) months follow-up, all patients had a normal liver function and US examination. Conclusions US-PED is technically feasible for choledochal cyst with giant cysts or coagulopathy in children, which can provide suitable conditions for subsequent definitive operation with a good overall prognosis. Trial registration: Retrospectively registered

Percutaneous Biliary Interventions in Pediatric Patients

“…Choledochal cysts are a rare entity in the western population with an incidence of 1:100,000, and are more common in the Asian population with an incidence of 1:13,000. 22 Given the risk of liver fibrosis and malignant transformation, the firstline treatment for choledochal cysts is immediate surgery with total excision of the cyst. If there are contraindications like liver dysfunction with coagulopathy, giant cysts, cholangitis, or malnutrition, PTBD can be chosen as a bridging therapy until surgery.…”

“…If there are contraindications like liver dysfunction with coagulopathy, giant cysts, cholangitis, or malnutrition, PTBD can be chosen as a bridging therapy until surgery. 3,22,23…”