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36 - Choledochal cyst

from Part IV - Abdomen

Published online by Cambridge University Press:  08 January 2010

By
Takeshi Miyano
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Takeshi Miyano
Affiliation:
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Introduction

Choledochal cyst is a congenital dilatation of the common bile duct and has the potential to become malignant. It has a hereditary predisposition, which may explain the higher incidence seen in Asia, particularly in Japan, and its familial occurrence in siblings and twins. It was first reported by Douglas in 1852 and may or may not be associated with congenital dilatation of the intrahepatic bile ducts (Fig. 36.1). Choledochal cyst is almost always associated with an abnormal junction between the pancreatic and common bile duct, i.e., pancreaticobiliary malunion. This allows pancreatic secretions to reflux into the biliary tree, and bile to flow into the pancreatic duct, causing various pathologic changes in the biliary tract, pancreas, and liver.

Because concurrent abnormalities of the pancreatic duct and intrahepatic bile ducts are almost always present, the importance of cholangiography in the planning of surgical management cannot be overemphasized. If these anomalies go unnoticed, aberrant pancreatic anatomy might be damaged, causing serious postoperative morbidity. Internal drainage of the choledochal cyst, a procedure popular in the past, has been abandoned for more than a decade now because of a prohibitive incidence of postoperative complications such as recurrent cholangitis, cholelithiasis, and biliary duct cancer. Primary cyst excision with biliary reconstruction to avoid two-way reflux of bile and pancreatic secretions is now the standard surgical treatment of choice.

Surgery for choledochal cyst is generally successful and a satisfactory surgical outcome with low morbidity is expected in the short term.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 465 - 479
Publisher: Cambridge University Press
Print publication year: 2006

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References

Miyano, T. & Yamataka, A.Choledochal cysts.Curr. Opin. Pediatr. 1997; 9:283–288.CrossRefGoogle ScholarPubMed
Lane, G. J.Different types of congenital biliary dilatation in dizygotic twins: a case report.Pediatr. Surg. Int. 1999; 15:403–404.CrossRefGoogle Scholar
Douglas, A. H.Case of dilatation of the common bile duct.Monthly. J. Med. Sci. 1852; 14:97–99.Google Scholar
Babbitt, D. P.Congenital choledochal cyst: new etiologic concepts on anomalous relationships of the common bile and pancreatic bulb.Ann. Radiol. 1969; 12:231–241.Google Scholar
Miyano, T., Suruga, K., & Suda, K.Abnormal choledocho-pancreatico ductal junction related to the etiology of infantile obstructive jaundice diseases.J. Pediatr. Surg. 1979; 14:16–25.CrossRefGoogle ScholarPubMed
Todani, T., Watanabe, Y., Toki, A.et al.Reoperation for congenital choledochal cyst.Ann. Surg. 1987; 207:142–147.CrossRefGoogle Scholar
Metcalfe, M. S., Wemyss-Holden, S. A., & Maddern, G. J.Management dilemmas with choledochal cysts.Arch. Surg. 2003; 138:333–333.CrossRefGoogle ScholarPubMed
Yamataka, A., Ohshiro, K., Okada, Y.et al.Complications after cyst excision with hepaticoenterostomy for choledochal cyst and their surgical management in children versus adults.J. Pediatr. Surg. 1997; 32:1097–1102.CrossRefGoogle ScholarPubMed
Todani, T., Watanabe, Y., Urushihara, N.et al.Biliary complications after excisional procedure for choledochal cyst.J. Pediatr. Surg. 1995; 30:478–481.CrossRefGoogle ScholarPubMed
Ohi, R., Yaoita, S., Kamiyama, T.et al.Surgical treatment of congenital dilatation of the bile duct with special reference to late complications after total excisional operation.J. Pediatr. Surg. 1990; 25:613–617.CrossRefGoogle ScholarPubMed
Arima, T., Suita, S., Kubota, M.et al.Endoscopic treatment of intrahepatic gallstones after surgery for choledochal cyst.Pediatr. Surg. Int. 1995; 10:218–220.CrossRefGoogle Scholar
Schier, F., Clausen, M., Kouki, M.et al.Late results in the management of choledochal cysts.Eur. J. Pediatr. Surg. 1994; 4:141–144.CrossRefGoogle ScholarPubMed
Chijiwa, K. & Tanaka, M.Late complications after excisional operation in patients with choledochal cyst.J. Am. Coll. Surg. 1994; 179:139–144.Google Scholar
Nagorney, D. M., MacIrath, D. C., & Adson, M. A.Choledochal cysts in adults: clinical management.Surgery 1984; 96:656–663.Google ScholarPubMed
Todani, T., Watanabe, Y., Mizuguchi, T.et al.Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst.Am. J. Surg. 1981; 142:584–587.CrossRefGoogle ScholarPubMed
Miyano, T., Yamataka, A., Kato, Y.et al.Hepaticoenterostomy after excision of choledochal cyst in children: A 30-year experience with 180 cases.J. Pediatr. Surg. 1996; 31:1417–1412.CrossRefGoogle ScholarPubMed
Miyano, T., Yamataka, A., Kato, Y.et al.Choledochal cysts: special emphasis on the usefulness of intraoperative endoscopy.J. Pediatr. Surg. 1995; 30:482–484.CrossRefGoogle ScholarPubMed
Ando, H., Ito, T., Kaneko, K.et al.Intrahepatic bile duct stenosis causing intrahepatic calculi formation following excision of a choledochal cyst.J. Am. Coll. Surg. 1996; 183:56–60.Google ScholarPubMed
Yoshikawa, K., Yoshida, K., Shirai, Y.et al.A case of carcinoma arising in the intrapancreatic terminal choledochus 12 years after primary excision of a giant choledochal cyst.Am. J. Gastroenterol. 1986; 81:378–384.Google ScholarPubMed
Yamamoto, J., Shimamura, Y., Ohtani, I.et al.Bile duct carcinoma arising from the anastomotic site of hepaticojejunostomy after the excision of congenital biliary dilatation: a case report.Surgery 1996; 119:476–479.CrossRefGoogle ScholarPubMed
Chaudhuri, P. K., Chaudhuri, B., Schuler, J. J.et al.Carcinoma associated with congenital cystic dilatation of bile ducts.Arch. Surg. 1982; 117:1349–1351.CrossRefGoogle Scholar
Deziel, D. J., Rossi, R. L., Munson, J. L.et al.Management of bile duct cysts in adults.Arch. Surg. 1986; 121:410–415.CrossRefGoogle ScholarPubMed
Shimura, H., Tanaka, M., Shimizu, S.et al.Laparoscopic treatment of congenital choledochal cyst.Surg. Endosc. 1998; 12:1268–1271.CrossRefGoogle ScholarPubMed
Mori, T., Abe, N., Sugiyama, M.et al.Laparoscopic hepatobiliary and pancreatic surgery: an overview.J. Hepatobiliary. Pancreat. Surg. 2002; 9:710–722.CrossRefGoogle ScholarPubMed
Tanaka, M., Shimizu, S., Mizumoto, K.et al.Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction.Surg. Endosc. 2001; 15:545–552.CrossRefGoogle ScholarPubMed
Watanabe, Y., Sato, M., Tokui, K.et al.Laparoscope-assisted minimally invasive treatment for choledochal cyst.J. Laparoendosc. Adv. Surg. Tech. A. 1999; 9:415–418.CrossRefGoogle ScholarPubMed
Alonso-Lej, F ., Rever, W. B., & Pessagno, D. J.Congenital choledochal cyst, with a report of 2, and an analysis of 94 cases.Int. Abst. Surg. 1959; 108:1–30.Google ScholarPubMed
Todani, T., Narusue, M., Watanabe, Y.et al.Management of congenital choledochal cyst with intrahepatic involvement.Ann. Surg. 1977; 187:272–280.CrossRefGoogle Scholar
Komi, N., Takehara, H., Kunitomo, K.et al.Does the type of anomalous arrangement of the pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst?J. Pediatr. Surg. 1992; 27:728–731.CrossRefGoogle ScholarPubMed
Todani, T. Choledochal cysts. In Stringer, M. D., Oldham, P., Mouriquand, D. E., Howard, E. R. eds. Pediatric Surgery and Urology: Long Term Outcomes. London: WB Saunders; 1998; 417–429.Google Scholar
Yamataka, A., Kuwatsuru, R., Shima, H.et al.Initial experience with non-breath-hold magnetic resonance cholangiopancreatography: a new noninvasive technique for the diagnosis of the choledochal cyst in children.J. Pediatr. Surg. 1997; 32:1560–1562.CrossRefGoogle Scholar
Shimotakahara, A., Yamataka, A., Kobayashi, H.et al.Massive debris in the intrahepatic bile ducts in choledochal cyst: possible cause of postoperative stone formation.Pediatr. Surg. Int. 2004; 20:67–69.CrossRefGoogle ScholarPubMed
Yamataka, A., Segawa, O., Kobayashi, H.et al.Intraoperative pancreatoscopy for pancreatic duct stone debris distal to the common channel in choledochal cyst.J. Pediatr. Surg. 2000; 35:1–4.CrossRefGoogle ScholarPubMed
Ando, H., Kaneko, K., Ito, F.et al.Operative treatment of congenital stenoses of the intrahepatic bile ducts in patients with choledochal cysts.Am. J. Surg. 1997; 173:491–494.CrossRefGoogle ScholarPubMed
Yamataka, A., Kobayashi, H., Shimotakahara, A.et al.Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children.J. Pediatr. Surg. 2003; 38:1830–1832.CrossRefGoogle ScholarPubMed
Shima, H., Yamataka, A., Yanai, T.et al.Intracorporeal electrohydraulic lithotripsy for intrahepatic bile duct stone formation after choledochal cyst excision: a case report.Pediatr. Surg. Int. 2004; 20:70–72.CrossRefGoogle Scholar
Lilly, J. R.Total excision of choledochal cyst.Surg. Gyn. Obst. 1978; 146:254–256.Google ScholarPubMed
Joseph, V. T.Surgical techniques and long-term results in the treatment of choledochal cyst.J. Pediatr. Surg. 1990; 25:782–787.CrossRefGoogle ScholarPubMed
O'Neill, J. A. Jr.Choledochal cyst.Curr. Prob. Surg. 1992; 29:361–410.CrossRefGoogle ScholarPubMed
Stringer, M. D., Dhawan, A., Davenport, M.et al.Choledochal cysts: lessons from a 20 year experience.Arch. Dis. Child. 1995; 73:528–531.CrossRefGoogle ScholarPubMed
Warren, K. W., Kune, G. A., Hardy, K. J.et al.Biliary duct cysts.Surg. Clin. North. Am. 1968; 88:567–577.CrossRefGoogle Scholar
Eagle, J. & Salmon, P. A.Multiple choledochal cysts.Arch. Surg. 1964; 88:345–349.Google Scholar
Csentino, C. M., Luck, S. R., & Raffensperger, J. G.et al.Choledochal duct cyst. Resection with physiological reconstruction.Surgery 1992; 112:740–748.Google Scholar
Voyles, C. R., Smadja, C., Shands, W. C.et al.Carcinoma in choledochal cysts.Arch. Surg. 1983; 118:986–988.CrossRefGoogle ScholarPubMed
Long, L., Yamataka, A., Segawa, O.et al.Coexistence of pancreas divisum and septate common channel in a child with choledochal cyst.J. Pediatr. Gastroenterol. Nutr. 2001; 32:602–604.Google Scholar
Kobayashi, S., Asano, T., Yamasaki, M.et al.Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction.Surgery 1999; 126:939–944.CrossRefGoogle ScholarPubMed
Ng, W. T. In “Letters to the editors”. Surgery 2000; 128: 492–494.
Okada, A., Nagaoka, M., Kamata, S.et al.“Common channel syndrome”: anomalous junction of the pancreatico-biliary ductal system.Z. Kinderchir. 1981; 32:144–151.Google ScholarPubMed
Lilly, J. R., Stellin, G. P., Karrer, F. M.Forme fruste choledochal cyst.J. Pediatr. Surg. 1985; 20:449–451.CrossRefGoogle ScholarPubMed
Aoki, T., Tsuchida, A., Kasuya, K.et al.Is preventive resection of the extrahepatic bile duct necessary in cases of pancreaticobiliary maljunction without dilatation of the bile duct?Jpn J. Clin. Oncol. 2001; 31:107–111.CrossRefGoogle ScholarPubMed
Murakami, T., Kodama, T., Takesue, Y.et al.Anomalous arrangement of the pancreaticobiliary ductal system without the dilatation of the biliary tract.Surg. Today 1992; 22:276–279.CrossRefGoogle ScholarPubMed
Morishita, H., Kamei, K., Funabiki, T.et al.A case of pancreaticobiliary maljunction without bile duct dilatation associated with gallbladder cancer and minute bile duct cancer.Tando 1992; 6:176–183.Google Scholar
Miyano, T., Ando, K., Yamataka, A.et al.Pancreaticobiliary maljunction associated with nondilatation or minimal dilatation of the common bile duct in children: Diagnosis and treatment.Eur. J. Pediatr. Surg. 1996; 6:334–337.CrossRefGoogle ScholarPubMed
Ando, H., Ito, T., Nagaya, M.et al.Pancreaticobiliary maljunction without choledochal cysts in infants and children: Clinical features and surgical therapy.J. Pediatr. Surg. 1995; 30:1658–1662.CrossRefGoogle ScholarPubMed
Tanaka, K., Nishimura, A., Yamada, K.et al.Cancer of the gallbladder associated with anomalous junction of the pancreaticobiliary duct system without bile duct dilatation.Br. J. Surg. 1993; 80:622–624.CrossRefGoogle Scholar
Witcombe, J. B. & Cremin, B. J.The width of the common bile duct in childhood.Pediatr. Radiol. 1978; 7:147–149.CrossRefGoogle ScholarPubMed
Schulman, M. H., Ambrosino, M. M., Freeman, P. C.et al.Common bile duct in children: sonographic dimensions.Radiology 1995; 195:193–195.CrossRefGoogle Scholar
Pushparani, P., Redkar, R. G., & Howard, E. R.Progressive biliary pathology associated with common pancreato-biliary channel.J. Pediatr. Surg. 2000; 35:649–651.CrossRefGoogle ScholarPubMed
Sugiyama, M. & Atomi, Y.Anomalous pancreaticobiliary junction without congenital choledochal cyst.Br. J. Surg. 1998; 85:911–916.CrossRefGoogle ScholarPubMed
Mori, K, Akimoto, R., Kanno, M.et al.Anomalous union of the pancreaticobiliary ductal system without dilatation of the common bile duct or tumor: case reports and literature review.Hepato-Gastroenterology. 1999; 46:142–148.Google ScholarPubMed
Rao, K. L. N., Mitra, S. K., Kochher, R.et al.Jejunal interposition hepaticoduodenostomy for choledochal cyst.Am. J. Gastroenterol. 1987; 82:1042–1045.Google Scholar
Todani, T., Watanabe, Y., Toki, A., et al. Hilar duct carcinoma developed after cyst excision followed by hepaticoduodenostomy. In Koyanagi, Y., Aoki, T., (eds) Pancreaticobiliary Maljunction, Tokyo: Igaku tosho shuppan; 2002; 17–21.Google Scholar
Shimotakahara, A., Yamataka, A., Yanai, T.et al.Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst; which is better?Pediatr. Surg. Int. 2005; 21:5–7.CrossRefGoogle ScholarPubMed
Lilly, J. R.Surgery of coexisting biliary malformations in choledochal cyst.J. Pediatr. Surg. 1979; 14:643–647.CrossRefGoogle ScholarPubMed
Burnweit, C. A., Birken, G. A., & Heiss, K.The management of choledochal cysts in the new born.Pediatr. Surg. Int. 1996; 11:130–133.CrossRefGoogle Scholar
Lugo-Vicente, H. L.Prenatally diagnosed choledochal cysts: observation or early surgery.J. Pediatr. Surg. 1995; 30:1288–1290.CrossRefGoogle ScholarPubMed
Lane, G. J., Yamataka, A., Kohn, S.et al.Choledochal cyst in the newborn.Asian J. Surg. 1999; 22:310–312.Google Scholar
Miyano, T. Congenital biliary dilatation. In Puri, P., ed. Newborn Surgery, Oxford, UK: Butterworth-Heinemann; 1996; 433–439.Google Scholar

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