ADULT CHOLEDOCHAL CYST - EXPERIENCE OF A TERTIARY CARE CENTER

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. ADULT CHOLEDOCHAL CYST - EXPERIENCE OF A TERTIARY CARE CENTER SATHEESH KUMAR MUTHUSAMY Department of Surgical Gastroenterology and Proctology, MADRAS MEDICAL COLLEGE AND GOVERNMENT GENERAL HOSPITAL An Initiative of The Tamil Nadu Dr M.G.R. Medical University University Journal of Surgery and Surgical Specialities Ultrasonography is the initial diagnostic tool. Complete excision is the treatment of choice whenever possible.