CHOLEDOCHAL CYST IN THE ADULT

Objective The authors examined the natural history of choledochal cyst s in adults treated surgically. Background An initial diagnosis of cho ledochal cyst is uncommon in adults, The recommended treatment is exci sion, rather than bypass, to achieve effective biliary drainage and be cause of the risk of cancer. Methods A retrospective study of 27 adult patients was completed to determine the frequency of anastomotic comp lications and the incidence of cancer. Results Fifteen patients were t reated by cyst excision, and one developed an anastomotic stricture, t reated by percutaneous dilation. Eight of 11 patients treated by cyst enterostomy required additional surgery for anastomotic revision. A fi nal patient was treated by T-tube drainage, Five of the seven patients with cancer have died at a mean of 21.6 months. Conclusion This exper ience documents the high incidence of cancer (26%), and high rate of s tricture after cyst enterostomy (73%). The dismal prognosis once cance r has developed warrants cyst excision, even in asymptomatic patients, including those with prior cyst enterostomies.