Changez Hakeem Khan.
Choledochal Cysts in Children and Adults.
J Coll Physicians Surg Pak Jan ;11(12):739-42.

Objective: To find out mode of presentation and management of choledochal cyst in children and adults. Design : A retrospective study. Place and Duration of Study: The study was conducted in the surgical `C` Unit of Khyber Teaching Hospital, Peshawar, Pakistan, between 1984-1996 (12 years). Subjects and Methods: The charts of the patients were studied for the history, investigations and the different surgical procedures carried out. Results: There were 9 cases, 5 children and 4 adults. Age range was 6 months – 28 years, with a male to female ratio of 1:3.8 There were 8 cases of Type-1 and one case of Type-V choledochal cyst (Todani`s classification). Pain was the presenting symptom in all cases. Jaundice was present in six cases (2 out of 4 in adults and 4 out of 5 in children). Seven patients presented with a mass. The cyst was spherical in shape in 6 and fusiform in 3. Cyst excision was possible in 5, while the rest had choledocho-duodenostomy, choldochorraphy, and trans-duodenal sphincterotomy in 1 (for Caroli`s disease). Conclusion: Over 80% of the cysts present are operated on below the age of 15 years. In adults, it is rare to find. Late presentation is because of mild jaundice. In between the attacks, the patient is free from symptoms. Cyst excision is difficult in adults due to increased vascularity associated due to portal hypertension, therefore, cyst anastomosis with either the duodenum or jejunum is safe, easy and associated with the least complications.

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