MANIFESTATIONS AND SURGICAL-TREATMENT OF CHOLEDOCHAL CYST IN DIFFERENT AGE GROUP-PATIENTS

Whether early surgery is necessary for asymptomatic choledochal cyst i s still controversial. In older to evaluate the manifestations of chol edochal cyst on different age group patients, we investigated 57 patie nts, 36 females and 21 males, who underwent surgery for choledochal cy st at National Taiwan University Hospital from July 1988 to June 1995. Of these, 93% were classified as type I according to the Alonzo-Lej o r Todani classification method. Patients were divided into three group s according to their age at surgery: group I, 14 infants (< 1-yr); gro up II, 28 children (1-16-yr); and group III, 15 adults (> 16 yr) The m ost common symptom in infants was jaundice, while abdominal pain was t he most frequent in children and adults. Preoperative evaluation of li ver function showed that alanine aminotransferase was higher in group II (160 +/- 77 IU/L) and group III (164 +/- 75 IU/L) than group I (74 +/- 28 IU/L). A higher tendency of biliary sludge and stone formation was noticed in group III (6/15, 40%) when compared with group I (2/14, 14.3%) and group II (5/28, 17.9%). The incidence of high bile amylase concentration in the choledochal cyst was higher in groups II (16/21, 76.2%) and III (9/11, 81.8%) than in group I (2/9, 22.2%). There were more inflammatory changes detected in the choledochal cyst wall and g all bladder by histologic examination in older patients (groups II and III). Therefore, an early surgery for choledochal cyst is suggested f or prevention of liver injury, biliary sludge, stone formation and pan creatitis.