Journal of Postgraduate Medicine
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CASE REPORT
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Year : 1991  |  Volume : 37  |  Issue : 3  |  Page : 183-4  

Choledochal cyst (a case report).

RD Shah, MB Jukar, SS Kowli 
 Department of Surgery, K. B. Bhaba Hospital, Bandra, Bombay, Maharashtra.

Correspondence Address:
R D Shah
Department of Surgery, K. B. Bhaba Hospital, Bandra, Bombay, Maharashtra.

Abstract

A case of choledochal cyst is presented. The cyst was found in an infant aged 40 days and was treated surgically by resection followed by Roux en-Y hepaticojejunostomy.



How to cite this article:
Shah R D, Jukar M B, Kowli S S. Choledochal cyst (a case report). J Postgrad Med 1991;37:183-4


How to cite this URL:
Shah R D, Jukar M B, Kowli S S. Choledochal cyst (a case report). J Postgrad Med [serial online] 1991 [cited 2022 May 17 ];37:183-4
Available from: https://www.jpgmonline.com/text.asp?1991/37/3/183/762


Full Text




  ::   IntroductionTop


Choledochal cyst is a rare congenital dilatation of the common bile duct, often associated with a congenital or acquired dilatation of intra-hepatic ducts. Clinically, it usually presents in infancy or childhood. We had under our care a 40-day-old child with choledochal cyst, whose findings and management is reported here.


  ::   Case reportTop


A 40-day-old male child, (full term normal delivery) weighing 3 kg presented with history of jaundice for 10 days, accompanied with high coloured urine, but normal coloured stools. There was a history of low grade fever since 5 days. No history of blood transfusion, any drug ingestion or Rh incompatibility was found.

Clinical examination revealed deep icterus. Liver was palpable; size was 2 fingers below costal margin, surface was smooth and non-tender. There was an ill-defined lump 4 x 4 cm palpable in the right hypochondrium, which was also non-tender and was not moving well with the respiration. No free fluid in the abdomen or any signs of liver cell failure were detected.

Biochemical parameters were as follows: Liver function tests showed serum bilirubin-14 mg%, SGOT216 IU, SGPT-154 IU and serum alkaline phosphatase - 36 KA units. Plain X-ray abdomen was normal. Ultra-sonography showed mild hepatomegaly with normal echo texture and a homogenous echogenic mass 4 x 4 cm in connection with the common bile duct. The mass was reported as choledochal cyst.

The patient was explored through an upper abdominal transverse emision. A cystic variety of choledochal cyst was found involving the entire common bile duct extending behind the duodenum. The gall bladder was opening into the cyst. Cholecystectomy with excision of the cyst with Roux en-Y hepaticojejunostomy was done. The patient tolerated the surgery well.

On 7th post-operative day liver function tests were repeated. Serum bilirubin was found to be 10 mg%, SGOT - 136 IU, SGPT - 42 IU and serum alkaline phosphatase 20 KA units. Repeat ultrasound showed a normal liver without any evidence of subplirenic collection.


  ::   DiscussionTop


Choledochal cyst is a rare anomaly of congenital origin, but the mechanism behind its above-mentioned formation remains unknown. The case is presented because of the early age of surgery. In a series of 21 cases reviewed by Kasai et al 4 the youngest patient was 2 months old. Another series of 11 cases operated by JR Lilly[5] had a patient of 1 months old. In 1980, Filler and Stringell reviewed 10 cases; only one of them was less than 1 month old (4 weeks) and choledochocystojejunostomy was carried out. In a series of 10 cases operated at the Children's Hospital Los Angeles, the youngest patient was 2 months old. The age incidence at the time of diagnosis in 259 cases compiled from world literature showed that 1. only 12% patients presented under the age of 1 year. 2 In a series of 37 cases operated by 2. Todani et al only 2 patients were less than 1 year old. Resection of the cyst remains the 3. treatment of choice -because it eliminates a reservoir for bile stasis, removes a mechanism, which allows continuous reflux of pancreatic juice into the cyst and prevents the development of bile duct carcinoma.


  ::   AcknowledgmentTop


We thank Dr. PS Paralkar, Medical Superintendent, KB Bhabha Hospital, for the help rendered.

References

1 Filler RM, Stringel G. Treatment of choledochal cyst by excision. J Paediatr Surg 1980; 15:437-442.
2Fonkalsrud EW. Choledochal cysts. Surg Clin North Amer 1973; 53:1275-1281.
3Hays DM, Goodman GN, Snyder WH Jr, Wooley MM. Congenital cystic dilatation of the common bile duct. Arch Surg 1969; 98:457-461.
4Kasai M, Asakura Y, Taira Y. Surgical treatment of choledochal cyst. Ann Surg 1970; 172:844-851.
5Lilly IR. The surgical treatment of choledochal cyst. Surg Gynaecol Obstel 1979; 149:36-42.
6Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts. Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cysts. Amer J Surg 1979; 134:263-269.

 
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