Congenital bile duct dilatation: review of 35 cases

Thirty-five patients with congenital bile duct dilatation or choledochal cyst were seen in the General Hospital, Kuala Lumpur, during a 10-year period from 1981 to 1990. The highest incidence occured in the group less than 1 year of age. Jaundice was the commonest symptom, occuring in 69% of patients. In most it was mild and intermittent, but a small group (29%) had persistent jaundice and acholic stools. These patients were all less than 1 year of age and represented a poor-prognosis group (30% mortality). Ultrasonography was the most useful diagnostic procedure, having an accuracy of 94%.The treatment of choice was total excision of the cyst and Roux-en-Y hepaticojejunostomy. Internal drainage procedures are not recommended because of the high incidence of cholangitis and the potential for malignancy occuring in the remnant cyst later in life. Operative mortality and morbidity were uncommon, and a good prognosis can be expected on long-term follow-up.