LATE SURGICAL COMPLICATIONS OF CHOLEDOCHAL CYSTOENTEROSTOMY

Choledochal cyst is a rare congenital abnormality of the biliary tract characterized by dilatation and stasis. Cyst excision is now preferre d to internal drainage because of the predilection for development of cancer in the unresected cyst wall. We report on four patients who req uired reoperations for complications of prior cystenteric drainage fro m 14 to 21 years after the original operations. Gastrointestinal bleed ing from cyst ulceration as occurred in one patient is heretofore unre ported. This reoperative experience emphasizes the importance of cyst excision as primary therapy and underscores these principles: 1) The s pectrum of complications, including infection, pancreatitis, cancer, a nd bleeding may occur with or without intracyst and ductal stones; 2) Radical operative procedures may be required for treatment of the comp lications; 3) Despite these, cholangiocarcinoma has a dismal prognosis ; 4) Patients whose cysts remain unexcised require meticulous lifelong scrutiny and strong consideration for planned reoperation at the time of the first complication.