Korean Journal of Radiology

  • 제23권2호
  • /
  • Pages.271-279
  • /
  • 2022
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Clinical and Radiologic Findings Between Perforated and Non-Perforated Choledochal Cysts in Children

  • Yu Jin Kim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Soo-Hyun Kim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • So-Young Yoo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Hye Kim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Soo-Min Jung (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sanghoon Lee (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong-Meen Seo (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung-Hoon Moon (Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Tae Yeon Jeon (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2021.03.03
  • 심사 : 2021.10.28
  • 발행 : 2022.02.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children. Materials and Methods: Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test. Results: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group. Conclusion: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.

키워드

참고문헌

  1. Jablon'ska B. Biliary cysts: etiology, diagnosis and management. World J Gastroenterol 2012;18:4801-4810 https://doi.org/10.3748/wjg.v18.i35.4801
  2. Diao M, Li L, Cheng W. Timing of choledochal cyst perforation. Hepatology 2020;71:753-756 https://doi.org/10.1002/hep.30902
  3. Chiang L, Chui CH, Low Y, Jacobsen AS. Perforation: a rare complication of choledochal cysts in children. Pediatr Surg Int 2011;27:823-827 https://doi.org/10.1007/s00383-011-2882-8
  4. Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 1980;140:653-657 https://doi.org/10.1016/0002-9610(80)90051-3
  5. Ando K, Miyano T, Kohno S, Takamizawa S, Lane G. Spontaneous perforation of choledochal cyst: a study of 13 cases. Eur J Pediatr Surg 1998;8:23-25 https://doi.org/10.1055/s-2008-1071113
  6. Tani C, Nosaka S, Masaki H, Kuroda T, Honna T. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space. Pediatr Radiol 2009;39:629-631 https://doi.org/10.1007/s00247-009-1189-6
  7. Ohkawa H, Takahashi H, Maie M. A malformation of the pancreatico-biliary system as a cause of perforation of the biliary tract in childhood. J Pediatr Surg 1977;12:541-546 https://doi.org/10.1016/0022-3468(77)90194-4
  8. Fukuzawa H, Urushihara N, Miyakoshi C, Kajihara K, Kawahara I, Isono K, et al. Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation. Pediatr Surg Int 2018;34:1079-1086 https://doi.org/10.1007/s00383-018-4321-6
  9. Ando H, Ito T, Watanabe Y, Seo T, Kaneko K, Nagaya M. Spontaneous perforation of choledochal cyst. J Am Coll Surg 1995;181:125-128
  10. Yamoto M, Urushihara N, Fukumoto K, Miyano G, Nouso H, Morita K, et al. Usefulness of laparoscopic cholecystostomy in children with complicated choledochal cyst. Asian J Endosc Surg 2015;8:153-157 https://doi.org/10.1111/ases.12170
  11. Paladugu R, Rau A, Schein M, Wise L. Spontaneous perforation of the hepatic duct in adults. Dig Surg 1998;15:417-420 https://doi.org/10.1159/000018655
  12. Suarez L, Detmer DE, Jarrett F. Surgical management of spontaneous hepatic duct perforations. Ann Surg 1981;194:176-179 https://doi.org/10.1097/00000658-198108000-00011
  13. Chen J, Tang Y, Wang Z, Wang Q, Wang D. Clinical value of ultrasound in diagnosing pediatric choledochal cyst perforation. AJR Am J Roentgenol 2015;204:630-635 https://doi.org/10.2214/AJR.14.12935
  14. Chang MY, Kim MJ, Han SJ, Kim HM, Lee MJ. Choledochal cyst rupture with an intrahepatic pseudocyst mimicking hepatic mesenchymal hamartoma in an infant. Clin Imaging 2015;39:914-916 https://doi.org/10.1016/j.clinimag.2015.04.016
  15. Tsai CC, Huang PK, Liu HK, Su YT, Yang MC, Yeh ML. Pediatric types I and VI choledochal cysts complicated with acute pancreatitis and spontaneous perforation: a case report and literature review. Medicine (Baltimore) 2017;96:e8306
  16. Yasufuku M, Hisamatsu C, Nozaki N, Nishijima E. A very low-birth-weight infant with spontaneous perforation of a choledochal cyst and adjacent pseudocyst formation. J Pediatr Surg 2012;47:E17-E19 https://doi.org/10.1016/j.jpedsurg.2012.03.055
  17. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-111 https://doi.org/10.1136/gutjnl-2012-302779
  18. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263-269 https://doi.org/10.1016/0002-9610(77)90359-2
  19. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 2003;10:340-344 https://doi.org/10.1007/s00534-002-0733-7
  20. Urushihara N, Hamada Y, Kamisawa T, Fujii H, Koshinaga T, Morotomi Y, et al. Classification of pancreaticobiliary maljunction and clinical features in children. J Hepatobiliary Pancreat Sci 2017;24:449-455 https://doi.org/10.1002/jhbp.485
  21. Schulte SJ, Baron RL, Teefey SA, Rohrmann CA Jr, Freeny PC, Shuman WP, et al. CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts. AJR Am J Roentgenol 1990;154:79-85 https://doi.org/10.2214/ajr.154.1.2104731
  22. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003;38:258-266 https://doi.org/10.1053/jhep.2003.50315
  23. Caironi P, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus 2009;7:259-267
  24. Xanthakos SA, Yazigi NA, Ryckman FC, Arkovitz MS. Spontaneous perforation of the bile duct in infancy: a rare but important cause of irritability and abdominal distension. J Pediatr Gastroenterol Nutr 2003;36:287-291
  25. Lee MJ, Kim MJ, Yoon CS. MR cholangiopancreatography findings in children with spontaneous bile duct perforation. Pediatr Radiol 2010;40:687-692 https://doi.org/10.1007/s00247-009-1447-7
  26. Fumino S, Iwai N, Deguchi E, Ono S, Shimadera S, Iwabuchi T, et al. Spontaneous rupture of choledochal cyst with pseudocyst formation-report on 2 cases and literature review. J Pediatr Surg 2006;41:e19-e21 https://doi.org/10.1016/j.jpedsurg.2006.02.033
  27. Cho MJ, Kim DY, Kim SC, Kim TH, Kim IK. Early vs. delayed surgery for choledochal cyst with acute pancreatitis in children. Hepatogastroenterology 2011;58:709-712
  28. Haller JO, Condon VR, Berdon WE, Oh KS, Price AP, Bowen A, et al. Spontaneous perforation of the common bile duct in children. Radiology 1989;172:621-624 https://doi.org/10.1148/radiology.172.3.2672089
  29. Smith R, Rosen JM, Alderson PO. Gallbladder perforation: diagnostic utility of cholescintigraphy in suggested subacute or chronic cases. Radiology 1986;158:63-66 https://doi.org/10.1148/radiology.158.1.3940399
  30. Dillehay G, Bar-Sever Z, Brown M, Brown R, Green E, Lee M, et al. Appropriate use criteria for hepatobiliary scintigraphy in abdominal pain: summary and excerpts. J Nucl Med 2017;58:9N-11N
  31. Runyon BA. Ascitic fluid bilirubin concentration as a key to choleperitoneum. J Clin Gastroenterol 1987;9:543-545 https://doi.org/10.1097/00004836-198710000-00011
  32. Ohba G, Yamamoto H, Nakayama M, Honda S, Taketomi A. Single-stage operation for perforated choledochal cyst. J Pediatr Surg 2018;53:653-655 https://doi.org/10.1016/j.jpedsurg.2017.07.014
  33. Ngoc Son T, Thanh Liem N, Manh Hoan V. One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases. Pediatr Surg Int 2014;30:287-290 https://doi.org/10.1007/s00383-014-3461-6