Choledochoceles: Are they choledochal cysts?

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

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)683-689
Number of pages7
JournalAnnals of Surgery
Volume252
Issue number4
DOIs
StatePublished - Oct 2010

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Choledochal Cyst
Pancreas
Cholangitis

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Ziegler, K. M., Pitt, H. A., Zyromski, N., Chauhan, A., Sherman, S., Moffatt, D., ... Grosfeld, J. L. (2010). Choledochoceles: Are they choledochal cysts? Annals of Surgery, 252(4), 683-689. https://doi.org/10.1097/SLA.0b013e3181f6931f

Choledochoceles : Are they choledochal cysts? / Ziegler, Kathryn M.; Pitt, Henry A.; Zyromski, Nicholas; Chauhan, Aakash; Sherman, Stuart; Moffatt, Dana; Lehman, Glen; Lillemoe, Keith D.; Rescorla, Frederick; West, Karen W.; Grosfeld, Jay L.

In: Annals of Surgery, Vol. 252, No. 4, 10.2010, p. 683-689.

Research output: Contribution to journalArticle

Ziegler, KM, Pitt, HA, Zyromski, N, Chauhan, A, Sherman, S, Moffatt, D, Lehman, G, Lillemoe, KD, Rescorla, F, West, KW & Grosfeld, JL 2010, 'Choledochoceles: Are they choledochal cysts?', Annals of Surgery, vol. 252, no. 4, pp. 683-689. https://doi.org/10.1097/SLA.0b013e3181f6931f
Ziegler, Kathryn M. ; Pitt, Henry A. ; Zyromski, Nicholas ; Chauhan, Aakash ; Sherman, Stuart ; Moffatt, Dana ; Lehman, Glen ; Lillemoe, Keith D. ; Rescorla, Frederick ; West, Karen W. ; Grosfeld, Jay L. / Choledochoceles : Are they choledochal cysts?. In: Annals of Surgery. 2010 ; Vol. 252, No. 4. pp. 683-689.
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abstract = "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.",
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AU - Sherman, Stuart

AU - Moffatt, Dana

AU - Lehman, Glen

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