Treatment of Choledochal Cyst in a Pediatric Population: A Case Series of Nine Patients from a Tertiary Care Teaching Medical Institution in Odisha, India

Abstract

Choledochal cyst (CD Cysts) are congenital bile duct anomalies wherein the cystic dilatations of the bile duct radicles could be intra or extrahepatic or both. Though rare, about 75% of these are detected in in childhood. If untreated, complications ensue. Definitive treatment includes completed surgical excision of the cyst and reconstruction of the bile duct but there is a lack of consensus on the optimal technique. In this paper, we present a summary of patients with CD cysts operated at our tertiary care centre in Odisha, India, that caters to a relatively under-resourced clientele, over the past six years.We analyzed the clinical profile (diagnosis, treatment and outcomes) of the patients.Wehad operated on nine patients – six males and three females, aged 15 months to 13 years. Eight children had presented with only pain.One child had pain, jaundice and a palpable mass in the right upper quadrant (classic triad). All had Type I biliary tract pathology. We managed seven of the children with hepaticojejunal (HJ) and Jejuno-jejunal (JJ) anastomoses in Roux-en-Y with an average length of stay in the hospital of 11.0±1.4 days, and the remaining two children with isolated jejunal loop (HJ, Jejuno-Duodenal (JD), and JJ) anastomosis with an average length of stay of 13.0±1.0 days. We did not have any complications reported immediately or during follow-up period ranging from month to 1 year. In our series,we recommend that HJ and JJ anastomoses in Roux-en-Y as the most preferred treatment for Type I choledochal cysts.