Orif Abstract

Case: Enbloc Excission, Choledochal Cyst; Roux-en-y; Hepatocojejunostomy, Left, Jackson Pratt, Drain

Title of Study: Choledochal Cysts in Adults and their Complications

Reference: Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland ; RW Parks, Department of Clinical & Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK

Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2020569/

Choledochal cysts are rare cystic transformations of the biliary tree that are increasingly diagnosed in adult patients. These congenital lesions have a female:-male preponderance of 4:1, with an incidence in the West of between 1 in 50 000 and 1 in 200 000 live births; they are much more frequent in Asia. Nearly 25% of choledochal cysts are detected in the first year of life and 60% in the first decade, but 20% are diagnosed after the age of 20 years. Adults with cysts are especially predisposed to the development of cholangiocarcinoma, with the cancer incidence increasing from 0.7% in the first decade of life to >14% after the age of 20 years. Several reports have documented long-term complications following the paediatric management of choledochal cysts using cystenterostomy without total cyst excision. Many centres now see an increasing number of adult patients who have either had previous operative procedures (without cyst excision) or experience ongoing complications related to a cyst in situ; up to 80% experience recurrent cholangitis and pancreatitis. Because of the risk of malignant change in choledochal cysts, the ideal treatment is excision of the entire dilated biliary tree with reconstruction using a Roux-en-Y hepaticojejunostomy. We present a contemporary cohort of adult patients with choledochal cysts, which emphasises the complexity and diversity of this disorder in adults.

Despite refinements in the management of choledochal cysts in children,...