THE MANAGEMENT OF CHOLEDOCHAL CYSTS IN THE NEWBORN

Choledochal cysts are now being diagnosed before birth on routine mate rnal sonography (US). There is no report in the literature outlining t he management of newborns with choledochal cysts, many of whom are asy mptomatic. Our study details the diagnosis, treatment and outcome of s ix such children, four girls and two boys. Five had antenatal US revea ling cystic abdominal masses. One had intermittent vomiting and US sug gested a choledochal cyst. Four of six had normal serum bilirubin leve ls; two had elevations. In five babies the choledochal cyst was correc tly diagnosed from the preoperative studies; in one the preoperative d iagnosis was an ovarian cyst. The children underwent an operation at a n average of 6 weeks of age (range 5 days to 17 weeks). At exploration , cholangiography showed Alonso-Lej type I cysts in all cases. Treatme nt consisted of resection of the cyst with Roux-en-Y choledochojejunos tomy in five and with a valved jejunal choledochoduodenal conduit in o ne. In no case was the dissection of the choledochal cyst off the port al vein and hepatic artery difficult. There were no intra- or early po stoperative complications. Mean hospital stay was 8 days (range 5 to 9 days). Presently, all 6 patients have normal bilirubin levels at an a verage length of follow-up of 35 months (range 16 to 70 months) after operation. We conclude that operative treatment of choledochal cysts i n early infancy, even in asymptomatic children, is safe and effective and may prevent serious complications later in life.