Perforated Choledochal Cyst: Its Clinical Implications in Pediatric Patient
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Purpose: Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions. Methods: A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups. Results: Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit. Conclusion: Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay.
Abstract
Purpose: Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions. Methods: A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups. Results: Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit. Conclusion: Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay.
참고문헌 (14)
- de Vries JS, "Choledochal cysts : age of presentation, symptoms, and late complications related to Todani's classification", J Pediatr Surg, 37, pp.1568~1573 (2002)
- Saing H, "Early and late results of excision of choledochal cysts", J Pediatr Surg, 32, pp.1563~1566 (1997)
- Ando H, "Spontaneous perforation of choledochal cyst", J Am Coll Surg, 181, pp.125~128 (1995)
- Ando K, "Spontaneous perforation of choledochal cyst : a study of 13 cases", Eur J Pediatr Surg, 8, pp.23~25 (1998)
- Yamoto M, "Usefulness of laparoscopic cholecystostomy in children with complicated choledochal cyst", Asian J Endosc Surg, 8, pp.153~157 (2015)
- Ohkawa H, "A malformation of the pancreatico-biliary system as a cause of perforation of the biliary tract in childhood", J Pediatr Surg, 12, pp.541~546 (1977)
- Ng WT, "Is spontaneous perforation of the bile duct in children due solely to pancreatico-biliary maljunction", Pediatr Surg Int, 18, pp.565~566 (2002)
- Northover JM, "A new look at the arterial supply of the bile duct in man and its surgical implications", Br J Surg, 66, pp.379~384 (1979)
- Lloyd JR, "The etiology of gastrointestinal perforations in the newborn", J Pediatr Surg, 4, pp.77~84 (1969)
- Arda IS, "Spontaneous rupture of extrahepatic choledochal cyst : two pediatric cases and literature review", Eur J Pediatr Surg, 15, pp.361~363 (2005)
- Yamaguchi M, "Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature", Am J Surg, 140, pp.653~657 (1980)
- Tan KC, "Choledochal cyst : a 14-year surgical experience with 36 patients", Br J Surg, 75, pp.892~895 (1988)
- Ngoc Son T, "One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases", Pediatr Surg Int, 30, pp.287~290 (2014)
- Ohba G, "Single-stage operation for perforated choledochal cyst", J Pediatr Surg, 53, pp.653~655 (2018)