Management of choledochal cysts- 7 years experience

Aim: to study presentation and management of choledochal cyst,its complications in children. methods: we performed a retrospective review of records of patients having choledochal cyst,(2006-2013) which were presented to sheikh zayed hospital,rahim yar khan,during last 7 years. we included clinical data,presentation,surgical management,post-operative complications (both early and late) and follow up data and analyzed and outcome recorded. results: there 14 patients in total out of which 6 were male and 8 were female patients. mean age of presentation was 7 years,the range being from 2 months to 18 years. the incidence was highest in 5-6 years. in our series 71% of the patients presented with pain right hypochondrium,29% presented with jaundice,29% presented with a palpable mass in right upper quadrant of abdomen and 14% presented with hepatomegaly. in 4(28%) of the patients initially external drainage was done then definitive surgery was done after optimization of the patients. in all patients choledochal cyst was excised and hepaticojejunostomy was done. our survival rate was 100% and complication rate- 21%. in 2(14%) choledochal cyst was adherent to portal vein and was excised by lilly's technique. in 1(7%) there hepatic ducts more than 2,in that patient anastomosis leak was detected on 4th post operative day and was referred to a higher centre where re-anastomosed and survived. in 1(7%) minor wound infection was recorded at 5th post operative day. conclusion: choledochal cyst is an important cause of jaundice with mass in right hypochondrium in neonates and recurrent right hypochondriac pain in older children. this disease should be kept in mind with high index of suspicions during examination of pediatric patients with above mentioned symptoms. early referral of these patients may guarantee a better outcome.