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Article
February 1978

Choledochal CystEtiological Considerations and Surgical Management in 22 Cases

Author Affiliations

From the Departments of Surgery (Drs Kimura, Tsugawa, Matsumoto, and Ogawa), Radiology (Dr Nishiyama), and Pathology (Dr Ito), Kobe (Japan) Children's Hospital, and the Department of Surgery (Drs Kubo, Yamamoto, and Asada), Kobe University School of Medicine.

Arch Surg. 1978;113(2):159-163. doi:10.1001/archsurg.1978.01370140049010
Abstract

• In a 14-year period from 1962 to 1976, there were 22 cases of choledochal cyst treated by two different approaches: choledochocystenterostomy to the duodenum in three and to the jejunum in a Roux-en-Y operation in four cases, and excision of the cyst with hepaticojejunostomy in 14 and with end-to-end anastomosis of the common bile duct in one case. There was one death in each group. In five cases, direct cholangiography, either operative or endoscopic, demonstrated a reflux of the contrast material from the biliary system to the pancreatic duct. In four cases, the amylase level of the cystic content was elevated, ranging from 182 to 50,820 Somogyi units. A reflux of the pancreatic juice into the biliary system was thought to be a possible cause of choledochal cyst. Excision of the cyst with hepaticojejunostomy in a Roux-en-Y operation seems to be the treatment of choice from the aspects of cholangitis, malignant change, and termination of the pancreatic reflux to the biliary system.

(Arch Surg 113:159-163, 1978)

References
1.
Babbitt DP:  Congenital choledochal cysts: New etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb . Ann Radiol 7:231-240, 1969.
2.
Babbitt DP, Starshak RJ, Clemett AR:  Choledochal cyst: A concept of etiology . Am J Roentgenol Radium Ther Nucl Med 119:57-62, 1973.Article
3.
Kasai M, Asakura Y, Taira Y:  Surgical treatment of choledochal cyst . Ann Surg 172:844-851, 1970.Article
4.
Ishida M, Tsuchida Y, Saito S, et al:  Primary excision of choledochal cysts . Surgery 68:884-888, 1970.
5.
Saito S, Ishida M:  Congenital choledochal cyst (cystic dilatation of the common bile duct) . Prog Pediatr Surg 6:63-90, 1974.
6.
Kimura S, Nakamura S, Tamaki Y, et al:  Complication in surgery of the bile ducts of infancy and childhood and their management . Jap J Pediatr Surg Med 8:715-724, 1976.
7.
Todani T, Tabuchi K, Narisue M, et al:  Choledochal cyst: Malignant change and treatment . Operation 24:763-772, 1970.
8.
Todani T, Okajima K, Tabuchi K, et al:  Choledochal cyst: Classification and treatment . Operation 29:875-880, 1975.
9.
Schaerli A, Bettex M:  Congenital choledochal cyst: Reconstruction of the normal anatomy . J Pediatr Surg 3:604-607, 1968.Article
10.
Hays DM, Goodman GN, Snyder WH, et al:  Congenital cystic dilation of the common bile duct . Arch Surg 98:457-461, 1969.Article
11.
Jones PG, Smith ED, Clarke M, et al:  Choledochal cysts: Experience with radical excision . J Pediatr Surg 6:112-120, 1971.Article
12.
Alonso-Lej F, Rever WB, Pessagno DJ:  Congenital choledochal cyst, with report of two, and an analysis of 94, cases . Int Abstr Surg 108:1-30, 1959.
13.
Arthur GW, Stewart JOR:  Biliary cysts . Br J Surg 51:671-675, 1964.Article
14.
Esguirra-Gomez G, Riveros-Gamboa E:  A case of multidiverticular cystic dilation of the common and hepatic ducts . Am J Roentgenol Radium Ther Nucl Med 94:477-479, 1965.
15.
Tsuchida Y, Ishida M:  Dilatation of the intrahepatic bile ducts in congenital cystic dilatation of the common bile duct . Surgery 69:776-781, 1971.
16.
Watts DR, Lorenzo GA, Beal JM:  Congenital dilatation of the intrahepatic biliary ducts . Arch Surg 108:592-598, 1974.Article
17.
Loubeau JM, Steichen FM:  Dilation of intrahepatic bile ducts in choledochal cyst . Arch Surg 111:1384-1390, 1976.Article
18.
Klotz D, Cohn BD, Kottmeier PK:  Choledochal cysts: Diagnosis and therapeutic problems . J Pediatr Surg 8:271-283, 1973.Article
19.
Williams LE, Fisher JH, Courtney RA, et al:  Preoperative diagnosis of choledochal cyst by hepatoscintography . N Engl J Med 283:85-86, 1970.Article
20.
Matsumoto Y, Kimura K, Kawai Y, et al:  Choledochal cyst . Rinsho-Geka 27:991-998, 1972.
21.
Komi N:  Pancreatico-biliary anomaly in congenital cystic dilatation of the bile duct . Operation 29:73-83, 1975.
22.
Barraya L, Pujor Soler R, Yvergneaux JP, quoted by Eaton SB, Ferrucci JT: Radiology of the Pancreas and Duodenum . Philadelphia, WB Saunders Co, 1973.
23.
Rienhoff WF, Pickrell KL:  Pancreatitis . Arch Surg 51:205-219, 1945.Article
24.
Goswitz JT, Kimmerling R:  Perforated choledochal cyst with bile peritonitis in an infant: Case report and surgical management . Surgery 59:878-882, 1966.
25.
Raffensperger J, in discussion, Donahoe PK, Hendren WH:  Bile duct perforation in a newborn with stenosis of the ampulla of Vater . J Pediatr Surg 11:823-825, 1976.Article
26.
Kato T, Asakura Y, Kasai M:  An attempt to produce choledochal cyst in puppies . J Pediatr Surg 9:509-513, 1974.Article
27.
Fonkalsrud EW, Boles ET:  Choledochal cysts in infancy and childhood . Surg Gynecol Obstet 121:733-742, 1965.
28.
Mahour GH, Lynn HB:  Choledochal cyst in children . Surgery 65:967-971, 1969.
29.
Duckett J, Eraklis AJ, Longino L:  Surgical treatment of idiopathic dilatation of the common bile duct (choledochal cyst) in 14 children . J Pediatr Surg 6:421-426, 1971.Article
30.
Macfarlance JR, Glenn F:  Carcinoma in choledochal cyst . JAMA 202:1003-1006, 1967.Article
31.
Lorenzo GA, Seed RW, Beal JM:  Congenital dilatation of the biliary tract . Am J Surg 121:510-517, 1971.Article
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