LONG-TERM RESULTS OF MANAGEMENT OF TYPE-I CHOLEDOCHAL CYSTS IN ADULTS

Choledochal cyst in adults is a rare condition. The present study desc ribes our experience with this abnormality of the biliary tree. During a 16-year period (1978-1993) eight adults with type I choledochal cys t were treated surgically in our departments. They were 4 men and 4 wo men with a mean age of 38.9 years (range 20-84). Symptoms, clinical fi ndings and abnormalities in laboratory investigations included pain in all patients, history of cholangitis (n = 3), cholangitis (n = 2), ac ute pancreatitis (n = 1), palpable mass (n 2), abdominal tenderness (n = 4), leucocytocis (n = 2), and increased levels of serum total bilir ubin (n = 4), SGOT (n = 2), and serum alkaline phosphatase (n 4). Diag nosis was established by intravenous cholangiography in one case, by C T-scanning in one, by ultrasonography in 5 and by intraoperative chola ngiography in one. All the patients were treated surgically. Three of them underwent a Roux-en-Y choledochocystoduodenostomy and one a chole dechocystoduodenostomy. The other 4 patients were treated with cyst ex cision and Roux-en-Y hepaticojejunostomy. There were no deaths among o ur patients. The mean follow-up period was 6.7 years (range 1-17). So far, five episodes of mild ascending cholangitis have occurred in the patient treated with choledochocystoduodenostomy. One patient in whom a Roux-en-Y choledochocystojejunostomy was performed had 2 episodes of right upper quadrant colic pain and one episode of cholangitis. Both these patients were treated conservatively. The other 6 patients had n o episodes of pain cholangitis or jaundice. In conclusion, the primary treatment of choledochal cyst type I is the excision of the cyst with Roux-en-Y hepaticojejunostomy. The Roux-en-Y choledochocystojejunosto my is indicated in cases where, for various reasons, the cyst can not be safely removed.