Choledochoceles: Are They Choledochal Cysts?
*Kathryn M. Ziegler, Henry A Pitt, *Nicholas J. Zyromski, *Aakash Chauhan, *Stuart Sherman, *Glen A. Lehman, Keith D. Lillemoe, Frederick J. Rescorla, *Karen W. West, Jay L. Grosfeld
Indiana University School of Medicine, Indianapolis, IN
OBJECTIVE(S): Choledochoceles have been classified as Type III choledochal cysts. However, most surgical series of choledochal cysts have reported few choledochoceles because they are managed primarily by endoscopists. Therefore, the aim of this analysis was to report a multidisciplinary series comparing choledochoceles to Types I, II, IV and V choledochal cysts.
METHODS: Surgical, endoscopic, and radiologic records were reviewed at our children’s and 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: One hundred forty-five patients with “choledochal cysts” including 44 children (29%) and 26 with choledochoceles (18%) were identified, which represents the largest Western series. The relative proportion of Types I (53%), II (6%), IV (15%) and V (8%) did not differ between adults and children. Types I, II, IV and V also were similar with respect to age, gender and presentation. Patients with choledochoceles, however, were more likely to be adult (25 vs 2%, p<0.05), older (55.5 vs 29.0 yrs, p<0.001), and male (42 vs 22%, p<0.05), to present with pancreatitis (60 vs 18%, p<0.001) to have pancreas divisum (31 vs 9%, p<0.01), and to develop a pancreatic neoplasm (8 vs 1%, p<0.08).
Choledochoceles differ from choledochal cysts with respect to age, gender, presentation, pancreatic ductal anatomy and propensity to develop pancreatic tumors. The significant associations between choledochoceles, pancreas divisum, and pancreatic neoplasms are new observations. Therefore, we conclude that classifications of choledochal cysts should not include choledochoceles.