Choledocal cyst (CC) is a rare congenital cystic dilation of bile duct and can be associated with serious complications including malignancy and inflammation of the surrounding anatomy. Approximately 80% of CC is diagnosed in infants and young children in their first decade of life. Complete surgical resection is recommended in patients with choledochal malformations with excellent outcome. Hereby we aimed to describe diagnosis and management aspects of choledochal cyst. A two years old girl complained intermittent abdominal pain in her upper right quadrant abdomen, accompanied with fever, nausea and vomiting and decrease of appetite. Physical examination, we found jaundice on sclera and palpabled liver 2 fingers below the costal arch. Abdominal ultrasound revealed cystic mass in right lower lobe, suggestive of hepatic cyst with inflammation of cystic head of pancreas and minimal free fluid in lumen. Abdominal CT-scan without contrast showed a choledocal cyst classified as Todani Type IV. A cyst in the bile duct was found during surgical procedure. In conclusion choledocal cyst as one of the differential diagnoses in children, which is characterized by intermittent right upper abdominal pain, jaundice and fever. Appropriate surgical measures should be undertaken to avoid complications.
| Published in | American Journal of Pediatrics (Volume 8, Issue 3) |
| DOI | 10.11648/j.ajp.20220803.13 |
| Page(s) | 168-172 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Children, Choledocal Cysts, Extrahepatal Cholestasis
| [1] | Hoilat GJ, John S. 2021. “Choledochal Cyst” Available from: https: //www.ncbi.nlm.nih.gov/books/NBK557762/ [Update 2021 Nov 7]. |
| [2] | Huang CS, Huang CC, Chen DF. Choledochal Cysts: Differences between Pediatric and Adult Patients. J Gastrointest Surg. 2010; 14 (7): 1105-10. doi: 10.1007/s11605-010-1209-8. |
| [3] | Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S. et al. Choledochal Cysts: Presentation, Clinical Differentiation, and Management. J Am Coll Surg. 2014; 219 (6): 1167-1180. doi: 10.1016/j.jamcollsurg.2014.04.023. doi: 10.1016/j.jamcollsurg.2014.04.023. |
| [4] | Moslim MA, Takahashi H, Seifarth FG, Walsh RM, Morris-Stiff G. Choledochal Cyst Disease in a Western Center: A 30-Year Experience. J Gastrointest Surg. 2016; 20 (8): 1453-63. doi: 10.1007/s11605-016-3181-4. |
| [5] | Ziegler KM, Pitt HA, Zyromski NJ, Chauhan A, Sherman S, Moffatt D, et al. Choledochoceles: Are They Choledochal Cysts? Ann Surg. 2010; 252 (4): 683-90. doi: 10.1016/j.yasu.2011.03.019. |
| [6] | Hill R, Parsons C, Farrant P, Sellars M, Davenport M. Intrahepatic Duct Dilatation in Type 4 Choledochal Malformation: Pressure-Related, Postoperative Resolution. J Pediatr Surg. 2011; 46 (2): 299-303. doi: 10.1016/j.jpedsurg.2010.11.008. |
| [7] | Rozel C, Garel L, Rypens F, Viremouneix L, Lapierre C, Décarie JC, et al. Imaging of Biliary Disorders in Children. Pediatr Radiol. 2011; 41: 208-20. doi: 10.1007/s00247-010-1829-x. |
| [8] | Lee SE, Jang JY, Lee YJ, Choi DW, Lee WJ, Cho BH, et al. Choledochal Cyst and Associated Malignant Tumors in Adults: a Multicenter Survey in South Korea. Arch Surg. 2011; 146: 1178-84. doi: 10.1001/archsurg.2011.243. |
| [9] | Bhavsar MS, Vora HB, Giriyappa VH. Choledochal Cysts: A Review of Literature. Saudi J Gastroenterol. 2012; 18 (4): 230-6. doi: 10.4103/1319-3767.98425. |
| [10] | Soares KC, Kim Y, Spolverato G, Maithel S, Bauer TW, Marques H, et al. Presentation and Clinical Outcomes of Choledochal Cysts in Children and Adults: A Multi-Institutional Analysis. JAMA Surgery, 2015; 150 (6): 577-84. doi: 10.1001/jamasurg.2015.0226. |
| [11] | Murphy A. J, Axt JR, Lovvorn HN., 3rd Associations between Pediatric Choledochal Cysts, Biliary Atresia, and Congenital Cardiac Anomalies. J Surg Res. 2012; 177: e59-63. doi: 10.1016/j.jss.2012.04.018. |
| [12] | De Angelis P, Foschia F, Romeo E, Caldaro T, Rea F, di Abriola GF, et al. Role of Endoscopic Retrograde Cholangiopancreatography in Diagnosis and Management of Congenital Choledochal Cysts: 28 Pediatric Cases. J Pediatr Surg. 2012; 47 (5): 885-8. doi: 10.1016/j.jpedsurg.2012.01.040. |
| [13] | Murphy AJ, Axt JR, Crapp SJ, Martin CA, Crane GL, Lovvorn HN 3rd. Concordance of Imaging Modalities and Cost Minimization in the Diagnosis of Pediatric Choledochal Cysts. Pediatr Surg Int. 2012; 28: 615-21. doi: 10.1007/s00383-012-3089-3. |
| [14] | Khandelwal C, Anand U, Kumar B, Priyadarshi RN. Diagnosis and Management of Choledochal Cysts. Indian J Surg. 2012; 74 (1): 29-34. doi: 10.1007/s12262-011-0388-1. |
| [15] | Sacher VY, Davis JS, Sleeman D, Casillas J. Role of Magnetic Resonance Cholangiopancreatography in Diagnosing Choledochal Cysts: Case Series and Review. World J Radiol. 2013; 5: 304-12. doi: 10.4329/wjr.v5.i8.304. |
| [16] | Tannuri ACA, Hara LAA, Paganoti GF, Andrade WC, Tannuri U. Choledochal Cysts in Children: How to Diagnose and Operate on. Clinics (Sao Paulo). 2020; 23; 75: e1539. doi: 10.6061/clinics/2020/e1539. |
| [17] | Diao M, Li L, Cheng W. Timing of Surgery for Prenatally Diagnosed Asymptomatic Choledochal Cysts: A Prospective Randomized Study. J Pediatr Surg. 2012; 47 (3): 506-12. doi: 10.1016/j.jpedsurg.2011.09.056. |
| [18] | Narayanan SK, Chen Y, Narasimhan KL, Cohen RC. Hepaticoduodenostomy Versus Hepaticojejunostomy after Resection of Choledochal Cyst: A Systematic Review and Meta-Analysis. J Pediatr Surg. 2013; 48 (11): 2336-42. doi: 10.1016/j.jpedsurg.2013.07.020. |
| [19] | Takeshita N, Ota T, Yamamoto M. Forty-year Experience with Flow-Diversion Surgery for Patients with Congenital Choledochal Cysts with Pancreaticobiliary Maljunction at a Single Institution. Ann Surg. 2011; 254: 1050-3. doi: 10.1097/SLA.0b013e3182243550. |
| [20] | Mabrut JY, Kianmanesh R, Nuzzo G, Castaing D, Boudjema K, Létoublon C, et al. Surgical Management of Congenital Intrahepatic Bile Duct Dilatation, Caroli's Disease and Syndrome: Long-Term Results of the French Association of Surgery Multicenter Study. Ann Surg. 2013; 258 (5): 713-21; discussion 721. doi: 10.1097/SLA.0000000000000269. |
| [21] | Ten Hove A, de Meijer VE, Hulscher JBF, de Kleine RHJ. Meta-analysis of Risk of Developing Malignancy in Congenital Choledochal Malformation. Br J Surg. 2018; 105 (5): 482-90. doi: 10.1002/bjs.10798. |
| [22] | Ohashi T, Wakai T, Kubota M, Matsuda Y, Arai Y, Ohyama T, et al. Risk of Subsequent Biliary Malignancy in Patients Undergoing Cyst Excision for Congenital Choledochal Cysts. J Gastroenterol Hepatol. 2013; 28: 243-7. doi: 10.1111/j.1440-1746.2012.07260.x. |
APA Style
Luh Made Diah Wulandari Artana, I Gusti Ngurah Sanjaya Putra, Kadek Deddy Ariyanta, I Putu Gede Karyana, Ni Nyoman Metriani Nesa, et al. (2022). Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl. American Journal of Pediatrics, 8(3), 168-172. https://doi.org/10.11648/j.ajp.20220803.13
ACS Style
Luh Made Diah Wulandari Artana; I Gusti Ngurah Sanjaya Putra; Kadek Deddy Ariyanta; I Putu Gede Karyana; Ni Nyoman Metriani Nesa, et al. Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl. Am. J. Pediatr. 2022, 8(3), 168-172. doi: 10.11648/j.ajp.20220803.13
AMA Style
Luh Made Diah Wulandari Artana, I Gusti Ngurah Sanjaya Putra, Kadek Deddy Ariyanta, I Putu Gede Karyana, Ni Nyoman Metriani Nesa, et al. Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl. Am J Pediatr. 2022;8(3):168-172. doi: 10.11648/j.ajp.20220803.13
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author = {Luh Made Diah Wulandari Artana and I Gusti Ngurah Sanjaya Putra and Kadek Deddy Ariyanta and I Putu Gede Karyana and Ni Nyoman Metriani Nesa and I Made Darmajaya},
title = {Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl},
journal = {American Journal of Pediatrics},
volume = {8},
number = {3},
pages = {168-172},
doi = {10.11648/j.ajp.20220803.13},
url = {https://doi.org/10.11648/j.ajp.20220803.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220803.13},
abstract = {Choledocal cyst (CC) is a rare congenital cystic dilation of bile duct and can be associated with serious complications including malignancy and inflammation of the surrounding anatomy. Approximately 80% of CC is diagnosed in infants and young children in their first decade of life. Complete surgical resection is recommended in patients with choledochal malformations with excellent outcome. Hereby we aimed to describe diagnosis and management aspects of choledochal cyst. A two years old girl complained intermittent abdominal pain in her upper right quadrant abdomen, accompanied with fever, nausea and vomiting and decrease of appetite. Physical examination, we found jaundice on sclera and palpabled liver 2 fingers below the costal arch. Abdominal ultrasound revealed cystic mass in right lower lobe, suggestive of hepatic cyst with inflammation of cystic head of pancreas and minimal free fluid in lumen. Abdominal CT-scan without contrast showed a choledocal cyst classified as Todani Type IV. A cyst in the bile duct was found during surgical procedure. In conclusion choledocal cyst as one of the differential diagnoses in children, which is characterized by intermittent right upper abdominal pain, jaundice and fever. Appropriate surgical measures should be undertaken to avoid complications.},
year = {2022}
}
TY - JOUR T1 - Extrahepatal Cholestasis Due to Choledochal Cyst Type Iv Todani Classification in Two Years Old Girl AU - Luh Made Diah Wulandari Artana AU - I Gusti Ngurah Sanjaya Putra AU - Kadek Deddy Ariyanta AU - I Putu Gede Karyana AU - Ni Nyoman Metriani Nesa AU - I Made Darmajaya Y1 - 2022/07/28 PY - 2022 N1 - https://doi.org/10.11648/j.ajp.20220803.13 DO - 10.11648/j.ajp.20220803.13 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 168 EP - 172 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20220803.13 AB - Choledocal cyst (CC) is a rare congenital cystic dilation of bile duct and can be associated with serious complications including malignancy and inflammation of the surrounding anatomy. Approximately 80% of CC is diagnosed in infants and young children in their first decade of life. Complete surgical resection is recommended in patients with choledochal malformations with excellent outcome. Hereby we aimed to describe diagnosis and management aspects of choledochal cyst. A two years old girl complained intermittent abdominal pain in her upper right quadrant abdomen, accompanied with fever, nausea and vomiting and decrease of appetite. Physical examination, we found jaundice on sclera and palpabled liver 2 fingers below the costal arch. Abdominal ultrasound revealed cystic mass in right lower lobe, suggestive of hepatic cyst with inflammation of cystic head of pancreas and minimal free fluid in lumen. Abdominal CT-scan without contrast showed a choledocal cyst classified as Todani Type IV. A cyst in the bile duct was found during surgical procedure. In conclusion choledocal cyst as one of the differential diagnoses in children, which is characterized by intermittent right upper abdominal pain, jaundice and fever. Appropriate surgical measures should be undertaken to avoid complications. VL - 8 IS - 3 ER -
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