Background: Choledochal cysts are rare, cystic dilatations of the biliary tract. Although they generally present in childhood, diagnosis is delayed to adulthood in 20-30%. They are significant due to potential hepatobiliary and pancreatic complications, as well as the lifetime risk for malignancy (8.4-26%). The aim of this study was to describe the presentation, treatment and complications of adult patients diagnosed with choledochal cysts over the last 15 years.

Methods:  A retrospective analysis of adult patients (³18 years) diagnosed with choledochal cysts between 1985 and 1998 was conducted. Hospital and clinic records of gastroenterologists/surgeons were reviewed, with data collected on age, sex, past medical history, clinical findings, lab findings and radiological investigations at the time of diagnosis. Cholangiograms, surgical interventions, complications and followup were also recorded.

Results: Seventeen patients were reviewed, with fourteen meeting inclusion criteria. There were nine female and five male patients, with a mean age of 47.0 years. (range 19 to 73 years). Abdominal pain was the presenting complaint in 86% (12/14), jaundice in 50% (7/14) and the classic triad of abdominal pain, abdominal mass and jaundice was only found in two (14%) patients. One patient presented acutely with cholangitis. Duration of symptoms ranged from acute to fifteen years. Whereas abnormal liver function tests were found in 71% (10/14), only 14% (2/14) had an elevated WBC. ERCP was attempted in all patients, with 85.7% success. Common channel length was abnormal (>15mm) in three patients. Nine choledochal cysts were Type I, two were Type II, two were Type IVa and there was one Type V. Cyst excision with a hepaticojejunostomy was performed on ten patients. One patient developed an adenocarcinoma of the common bile duct and died from this, despite having choledochal cyst excision and unremarkable histology. Two patients had recurrent cholangitis and one had a postoperative leak with abscess formation.

Conclusion: Choledochal cysts can present in adulthood with significant sequelae. Complications such as cholangiocarcinoma and recurrent cholangitis occur despite currently accepted medical and surgical management. However, early diagnosis with techniques such as ERCP and surgical excision can lead to symptom relief and prolonged survival in most patients.

NEXT ABSTRACT >