Experiences of choledochal cyst in pediatric and adult population: A case series

Abstract

Introduction: Choledochal cysts are a relatively uncommon disease of the bile duct which is the cystic dilatation of the intra- or extrahepatic bile ducts. Literature is scarce on its clinicopathological behavior among children and adults and its comparison. Methods: The retrospective study was aimed to study the clinical characteristics, management, and complications between pediatric and adult patients with choledochal cysts. Results: There was higher female preponderance with male to female ratio of 3:17 in pediatric age group while 1:4 in adult age. Abdominal pain was more common among adults, while palpable mass was more common among pediatrics population (P < 0.05). Jaundice was more evident in the pediatric age group, yet the classic triad of choledochal cyst (abdominal pain, jaundice, and a palpable mass) was not observed in any age group. About 76% of the cysts were type 1 cysts, which was more common among pediatric age group (40% vs. 90% P < 0.05) while with adults presented more with a type IVA cyst (60% vs. 10% P > 0.05). No patients with type II, type III, type IVB cysts, or type V were found. Sixteen patients underwent Lilly technique, with resection of the choledochal mucosa and Roux-en-Y hepaticojejunostomy, while nine patients underwent resection of the choledochal cyst and Roux-en-Y hepaticojejunostomy. Patients who received total excision had fewer surgical complications in both groups. Conclusion: Although there is a significant difference in the clinical characteristics of choledochal cysts between children and adults, yet early detection and necessary surgery is essential for patients with choledochal cysts.