Surgical treatment of idiopathic dilatation of the common bile duct (choledochal cyst) in 14 children

Summary Fourteen children, 7 days to 14 yr of age, were treated for a choledochal cyst. Three infants under 2 mo of age initially presented with a clinical picture difficult to distinguish from biliary atresia. Two other infants first seen under 2 mo of age, thought to have hepatitis, were not operated upon until 4 1/2 and 14 mo of age, by which time they had developed serious biliary cirrhosis. One of these children died of cholangitis. An anastomosis between the cyst or common duct with the anterior wall of the duodenum was the procedure carried out in 12 of the 14 cases. The 12 children with a choledochal cyst-duodenostomy or choledocho-duodenostomy are alive and well from 2 to 19 yr after repair without evidence of ascending cholangitis or other symptoms. During the follow-up period, no secondary surgical procedures were necessary. It is important that a wide anastomosis between the duodenum and the most dependent portion of the cyst be created for adequate drainage and satisfactory long-term results. Also emphasized is the need for confirmation of the diagnosis of the young infant with jaundice.