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Pediatric choledochal cysts: diagnosis and current management

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A Letter to the Editor to this article was published on 13 November 2017

Abstract

Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.

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    Authors and Affiliations

    1. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

      Kevin C. Soares

    2. Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

      Seth D. Goldstein & David J. Hackam

    3. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

      Mounes A. Ghaseb & Ihab Kamel

    4. The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Department of Surgery, Wexner Medical Center, Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

      Timothy M. Pawlik

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    Kevin C. Soares and Seth D. Goldstein contributed equally to this work.

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    Soares, K.C., Goldstein, S.D., Ghaseb, M.A. et al. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 33, 637–650 (2017). https://doi.org/10.1007/s00383-017-4083-6

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