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ADULT CHOLEDOCHAL CYST - EXPERIENCE OF A TERTIARY CARE CENTER

SATHEESH KUMAR MUTHUSAMY

Abstract


Aim of this Study-A retrospective analysis
of 35 adults being diagnosed as having
choledochal cyst and managed in our
department over a period of 7
years.Patients and Methods-During the
period from February 2005 to January
2012, 35 patients between 15 and 47
years of age were diagnosed as having
choledochal cyst and were managed in
our department. The medical records
and the investigations of these patients
were reviewed and an analysis was
done. Results-The study included 20 females
and 15 males. The classical triad
of jaundice, mass and abdominal pain
was seen in only three of our patients.
The most common presentation was Abdominal
pain. Ultrasonography was diagnostic
in most of the patients and the diagnosis
was confirmed with a Magnetic
Resonance Cholangio-pancreatography
(MRCP). The cysts were categorized according
to Todanis classification - 27 patients
belonged to type I, 6 patients to
type IV and 1 patient to type V cysts. The
size of the cyst varied
from 3 to 22cms. One patient had undergone
a cysto-duodenostomy elsewhere
and she had cholangiocarcinoma in the
cyst wall. Surgical procedure performed
was complete excision of the cyst with
Roux en Y- hepaticojejenostomy in 27 patients,
partial excision of the cyst and cauterisation
of the remaining cyst wall with
Roux en Y- hepaticojejenostomy in 6 patients
and conservative management in 1
patient with diffuse intrahepatic cysts. Postoperative
complications specific to the
choledochal cyst included bile leak in 5 patients,
cholangitis in 2 patients and temporary
pancreatic enzyme elevation in 2 patients.
All of them improved upon conservative
treatment in the early postoperative
period. There was no post-operative mortality.
Two patients have died due to
causes unrelated to Choledochal cyst and
others have remained well during the follow
-up. Conclusion-Choledochal cyst in adults
presents a distinctly different clinical picture.
The classic triad of jaundice, abdominal
pain and mass is rarely seen. Diagnosis
is often delayed as the clinical presentation
is widely variable.

Ultrasonography is the initial diagnostic tool.
Complete excision is the treatment of choice
whenever possible.


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