Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal

Abstract

Introduction
Choledochal cysts (CC) are infrequent congenital cystic dilation of the biliary tract presenting with various symptoms and are managed by surgery. Aim of the study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts undergoing surgery.

Method
This is a retrospective study of 32 consecutive patients of choledochal cysts who underwent multidisciplinary management in the preceding two and half years at a tertiary referral center from Nepal.

Result
A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31 (96.88%), jaundice 10 (31.25%) and mass 5 (15.63%). Triad of pain, jaundice and mass was present in 4 (12.5%). Transabdominal ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (68.75%), and contrast enhanced computed tomography (31.25%). Endoscopic retrograde cholangiopancreatography was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy. Postoperative complication was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination.

Conclusion
Choledochal cyst was common in young female. Type IC and IVA Choledochal cyst were the most common type and majority of them were symptomatic.