Clinical Characteristics of the Pediatric Patients with Pre-natally and Post-natally Diagnosed Choledochal Cysts
The choledochal cysts have been known as the ductal dilatation caused by an anomalous pancreaticobiliary duct union(APBDU). Recently by the help of the diagnostic techniques, choledochal cysts have been much more reported in the prenatal period. The pre-natally diagnosed choledochal cysts were known to differ from child or adult type. This study could be helpful to understand the pathogenesis of disease. We retrospectively reviewed the records of 31 pediatric patients with the choledochal cysts surgically treated between June 1994 and April 2010 at the department of surgery, Ajou university hospital. The patients were divided into two groups with accordance to the time of diagnosis: pre-natally and post-natally diagnosed choledochal cysts. The group of pre-natally diagnosed choledochal cysts included 7 patients. The mean age at the time of surgical treatment in this group was 25.7 days after birth. Among 24 patients in the post-natally diagnosed group, 21(87.5%) and 17(70.8%) patients had abdominal pain and nausea/vomiting retrospectively, while 1 patient(14.3%) had abdominal mass and other patient had nausea/vomiting retrospectively in the other group. In post-natally diagnosed choledochal cysts, the level of intraductal amylase was much higher than the group of pre-natally diagnosed choledochal cysts.(32897.4IU vs 2.61IU, p<0.01) 6 patients(85.7%) with pre-natally diagnosed choledochal cysts had the type I according to Todani's classification, whereas 14 patients(58.3%) with post-natally diagnosed choledochal cysts had the type IV. The APBDU was found in 1 patients(14.3%) with pre-natally diagnosed group and 18(75%) with post-natally diagnosed group.(p=0.007) The severe postoperative complication was not found in both groups. In pre-natally diagnosed patients, the mean level of intraductal amylase was low and the APBDU was rarely found. This finding is not correlated to the previous theory about the reflux of pancreatic juice. The pathogenesis of choledochal cysts could be explained in the other way than APBDU theory.
산전, 산후, 소아 담관낭종, Pediatric Patients, Pre-natally, Post-natally, Choledochal Cyst
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