Perforation: a rare complication of choledochal cysts in children
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Liwei Chiang • Chan Hon Chui • Yee Low • Anette Sundfor Jacobsen
- چاپ و سال / کشور: 2011
Description
Purpose Spontaneous perforation is a rare complication of choledochal cyst (CDC) which is difficult to diagnose due to its nonspecific clinical presentation. The surgical treatment can be either single-staged cyst excision or twostaged procedure with an initial drainage followed by delayed cyst excision. Both biliary duct obstruction and irritation due to refluxed pancreatic juice have been proposed as possible aetiology. In this report, we describe six cases of CDC perforation in hope to have a better understanding on the clinical features and cause of this complication. Methods Medical records of six patients whose diagnoses of perforated CDC were confirmed with intra-operative findings were retrospectively reviewed. Clinical data, investigation results and post-operative outcomes were analysed. Results Vomiting and abdominal pain were the most common complaints. Few patients present with clinical jaundice. Overt sign of peritonitis was absent. Both singlestaged and two-staged approach offered satisfactory outcome. Conclusion Hyperbilirubinaemia and remote free intraperitoneal fluid allude the diagnosis of perforated CDC. When presenting with cholangitis, it warrants timely surgical intervention to prevent perforation. Single-staged or two-staged surgical approach would depend on stability of patient and surgical expertise available. Reversible dilatation of intra-hepatic duct suggests that increased intraductal pressure is a contributing factor to the perforation.
Pediatr Surg Int (2011) 27:823–827 DOI 10.1007/s00383-011-2882-8 Accepted: 23 February 2011 / Published online: 12 April 2011
