Surgical management of cystic dilatation bile ducts in adults

BACKGROUND: The cystic dilatation of the biliary tract is a rare disease and uncertain origin. It is recognized more frequently in children; however, its incidence comes increasing in adults, representing 20% of the cases. AIM: To evaluate morbimortality rates, evolution and handing of patients with cystic dilatation bile ducts in adults. METHODS: Were evaluated, retrospectively, five adults who had the diagnosis of choledochal cyst and that had been submitted to some surgical procedure. RESULTS: Abdominal pain was the commonest complain to all patients. Jaundice was present in 80%. Ultrasound scanning was done in all the cases as initial examination. CT scan, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography were also done in some patients; however, the diagnosis was established intra-operatively in all cases. The cyst resection with reconstruction of the biliary tract was done in 60%; the cystojejunostomy in 20%; and in 20% biliary tract drainage. CONCLUSIONS: Biliary tract cystic dilatation is a rare disease. However, its incidence is increasing in the adult population, so, it must be thought as differential diagnosis when facing obstructive jaundice.

背景：胆道囊性扩张症（cystic dilatation of the biliary tract）是一类病因不明的罕见疾病，既往更常于儿童群体中被确诊；但近年来成人患者的发病率呈上升趋势，其病例占总确诊病例的20%。
研究目的：旨在评估成人胆道囊性扩张症患者的并发症发生率与病死率、疾病转归及诊疗策略。
方法：本研究回顾性分析了5例经确诊为胆总管囊肿（choledochal cyst）并接受外科手术治疗的成人患者。
结果：腹痛为所有患者最常见的主诉；80%的患者出现黄疸。所有患者均以超声扫描作为初始检查手段，部分患者还追加了计算机断层扫描（CT）、磁共振成像（MRI）及内镜逆行胰胆管造影（ERCP）检查，但所有病例均经术中确诊。其中60%的患者接受了囊肿切除联合胆道重建术，20%接受了囊肿空肠吻合术，剩余20%接受了胆道引流术。
结论：胆道囊性扩张症是一种罕见疾病，但其在成人人群中的发病率正逐年升高，因此在接诊梗阻性黄疸患者时，需将其纳入鉴别诊断范畴。