Seven Cases of Choledochal Cyst With Biliary Duct Perforation

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  • Suzuki Komei
    Department of Pediatric Surgery, Shizuoka Children's Hospital:Department of Pediatric Surgery, Children's Medical Center, Showa University Northern Yokohama Hospital
  • Urushihara Naoto
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Fukumoto Koji
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Fukuzawa Hiroaki
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Watanabe Kentaro
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Nagae Hideki
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Mitsunaga Maki
    Department of Pediatric Surgery, Shizuoka Children's Hospital
  • Hasegawa Shiro
    Department of Pediatric Surgery, Shizuoka Children's Hospital

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Other Title
  • 胆道穿孔をきたした先天性胆道拡張症7例の臨床的検討
  • タンドウ センコウ オ キタシタ センテンセイタンドウ カクチョウショウ 7レイ ノ リンショウテキ ケントウ

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Abstract

Purpose: Bile duct perforation (BDP) is a rare complication of choledochal cyst. We investigated the clinical features and management of choledochal cyst associated with BDP. Methods: One hundred and fifty-five patients with choledochal cyst were treated at our institution, and we reviewed clinical courses in seven patients with BDP (4.5%). Results: The age of them ranged from 1 to 5 years old, and they consisted of 2 males and 5 females. It took 3 to 13 days from onset to the first surgery. Five patients were diagnosed with choledochal cyst before the BDP. The shape of the extrahepatic bile duct was fusiform in 6 patients. The sites of perforation were in the anterior wall of the common bile duct in 5, and in the posterior wall in 2. In all cases, the initial surgical management was abdominal drainage and biliary drainage such as cholecystostomy or T-tube drainage; a biliary reconstruction was performed about one month after the first operation. Conclusions: Because infant cases with fusiform shape of the extrahepatic bile duct are one of the risk factors of BDP, we recommend careful observation with ultrasono-graphic study and blood examination in those cases. We consider that a primary biliary reconstruction is possible in selected patients with BDP, but biliary and abdominal drainage are safe initial treatment for BDP.

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