Treatment of congenital choledochal cyst in adults

Introduction: Choledochol cysts are uncommon biliary lesions. Considering the evolution of imaging, we describe our experience with the presentation and management of choledochal cysts in adults. Methods: A retrospective review of our database that was managed for primary choledochal cysts was performed. Results: Between 1998 and 2014, 20 adults were managed for primary choledochal cysts disease. The average age was 44 years (29–71) and 77% were female. Presentation included biliary sepsis and abdominal pain 80%, Colecistitis aguda 15%, pancreatitis 5%. Three patients had associated colangiocarcinoma, two at the moment of diagnosis (10%) and 1 in the explanted liver. Irresecable 1 and two are alive at 8 years (1 resection and 1transplantation). The cysts were classified (TODANI): I: 9 A: 4 C: 5; II: 3; III: 2; IV B 1 and V: 5. The patients underwent complete excision of the cyst and hepaticojejunostomy were 13 (1 laparoscopy). Endoscopic treatment 1 and 1 observation (III). Three patients (V) required resection of the liver and 1 with diffuse Caroli's liver transplantation. Postoperative morbidity was biliary leaks 2, subphrenic abscess 1, wound infection, 1 pneumonia 1 and 3 cholangitis. No postoperative mortality. Two patients deaths, 1 who had colangiocarcinoma at 6 months and 1 of Caroli disease at 5 years of renal cancer. Conclusion: Choledocochal cysts should be considered in all patients presenting with biliary colic, pancreatitis and cholangitis with associated dilatation of bile duct. Complete excision of the cysts with restoration by hepaticojejunostomy form the basis of ideal treatment.