Portal de Periódicos da CAPES

Choledochoceles

2010; Lippincott Williams & Wilkins; Volume: 252; Issue: 4 Linguagem: Inglês

10.1097/sla.0b013e3181f6931f

1528-1140

Kathryn M. Ziegler, Henry A. Pitt, Nicholas J. Zyromski, Aakash Chauhan, Stuart Sherman, Dana C. Moffatt, Glen A. Lehman, Keith D. Lillemoe, Frederick J. Rescorla, Karen W. West, Jay L. Grosfeld,

Congenital Anomalies and Fetal Surgery

In Brief Objective: The aim of this analysis was to report a multidisciplinary series comparing choledochoceles to Todani Types I, II, IV, and V choledochal cysts. Summary Background Data: Choledochoceles have been classified as Todani Type III choledochal cysts. However, most surgical series of choledochal cysts have reported few choledochoceles because they are managed primarily by endoscopists. Methods: Surgical, endoscopic, and radiologic records were reviewed at the Riley Children's Hospital and the Indiana University Hospitals to identify patients with choledochal cysts. Patient demographics, presenting symptoms, radiologic studies, associated abnormalities, surgical and endoscopic procedures as well as outcomes were reviewed. Results: A total of 146 patients with "choledochal cysts" including 45 children (31%) and 28 with choledochoceles (18%) were identified, which represents the largest Western series. Patients with choledochoceles were older (50.7 vs. 29.0 years, P < 0.05) and more likely to be male (43% vs. 19%, P < 0.05), to present with pancreatitis (48% vs. 24%, P < 0.05) rather than jaundice (11% vs. 30%, P < 0.05) or cholangitis (0% vs. 21%, P < 0.05), to have pancreas divisum (38% vs. 10%, P < 0.01), and to be managed with endoscopic therapy (79% vs. 17%, P < 0.01). Two patients with choledochoceles (7%) had pancreatic neoplasms. Conclusions: Patients with choledochoceles differ from patients with choledochal cysts with respect to age, gender, presentation, pancreatic ductal anatomy, and their management. The association between choledochoceles and pancreas divisum is a new observation. Therefore, we conclude that classifications of choledochal cysts should not include choledochoceles. This series of 146 patients with choledochal cysts, including 28 patients with choledochoceles, represents the largest single institution series in the Western literature. Patients with choledochoceles differ from patients with choledochal cysts in their age, gender, presentation, pancreatobiliary anatomy, and management. Therefore, they should not be classified as patients with choledochal cysts.