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ORIGINAL ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 15-33

Clinical profile and outcome of choledochal cysts in a pediatric tertiary hospital from 2000 to 2013


Philippine Children’ s Medical Center Quezon Avenue corner Agham Road, Quezon City, Philippines

Correspondence Address:
Odessa C del Rosario-Bayani
Philippine Children’ s Medical Center Quezon Avenue corner Agham Road, Quezon City
Philippines
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Source of Support: None, Conflict of Interest: None


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Background: In spite of early surgical intervention of choledochal cysts to prevent adverse outcomes, a few still develop significant morbidity and mortality. Determining which factors affect outcome will aid in the management and care of patients with choledochal cysts. Objective: This study aims to determine the clinical profile of patients with choledochal cyst and determine the factors affecting its outcome. Methodology: A retrospective cohort study of patients with choledochal cysts 0-18years old was done. Clinical data were correlated with the outcome which include immediate postoperative complications, portal hypertension and mortality. Results: A total of 77 patients with choledochal cyst were studied. Majority were >2-5 years old at 31% (n=24/77). The mean age at onset of symptoms was at 2.75 years old. The most common cyst type was type I at 79% (n=61) followed by 16% type IV (n=12), 3% type III (n=2) and 1% type V (n=1). There was no type II cyst. Age had a significant association with the clinical manifestations with jaundice, abdominal distention and hepatosplenomegaly found in less than 2 years old and abdominal pain in 5-7 years old (P≤0.05). Classic triad was significantly associated with cyst type III (50%) and IV (20%). 91% underwent surgery (n=70/77) with cyst excision and hepaticoenterostomy being the most commonly used (n=51/77, 66%).17% had immediate postoperative complications (n=12/70) with infection (n=7/12) being the most common complication significantly found in less than 2years old (n=5/7). 13% had portal hypertension (n=10/77) significantly found in those whose onset of symptoms was less than 2 years old (n=9/10) and Type I cysts (n=6/10). 6.5% died (n=5/77) and was significantly highest in those whose onset of symptom was less than 2 years old (n=4/5). Conclusions: Particular attention to diagnose, provide timely intervention and anticipatory care of possible complications should be given to infants with choledochal cysts because they were significantly associated with immediate postoperative complication particularly infection, development of portal hypertension and mortality. Recommendations: It is recommended to include a bigger population size and follow-up studies to monitor long-term complications of patients with choledochal cysts.


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