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Clinical Studies on the Biliary Cyst in Childhood.

Journal of the Korean Pediatric Society 1985;28(6):570-580.
Published online June 30, 1985.
Clinical Studies on the Biliary Cyst in Childhood.
Young Yull Koh
Department of Pediatrics,College of Medicine,Seoul National University
소아 담관낭종의 임상적 고찰
서울대학교 의과대학 소아과학교실
Cystic abnormalities may occur throughout the biliary ductal system from the finest intralobular hepatic ducts to the intraduodenal portion of the common bile duct. Clinical studies were performed on 18 cases of the biliary cyst who have been admitted to the Pediatric and Pediatric Surgical Dept. 1 of SNUH from January 1979 to December 1984. Results were obtained as follows: 1)Onset of symptoms occurred from early neonatal period to 6 years of agei In one third, onset occurred under 12 months of age. Of 18 patients, 5(28%) were male and 13(72%) were female: The ratio of male to female was 1 to 2.6. The duration of symptoms prior to diagnosis ranged from less than one week to more than 10 years. 2)The chief clinical symptoms are generally said to be abdominal pain, jaundice and abdominal mass; Only 3 cases (17%) had the three chief symptoms. The most common symptom was jaundice (78%), the second most common were hepatomegaly and abdominal mass (56% respectively), and the fourth abdominal pain (50%). The less common symptoms were abdominal distention, fever, nausea and vomiting, splenomegaly and dark urine. The duration of symptoms prior to diagnosis in the cases with the classic triad was longer significantly than that in the cases without the triad. 3)Review of the preoperative laboratory data showed elevation of serum total and direct bilirubin (13 cases in 18), serum GOT and/or GPT (15 cases in 17), cholesterol (6 cases in 8) and alkaline phosphatase (11 cases in 13). 4) Preoperative diagnosis was made correctly in 16 cases (89%), 4 of which were diagnosed clinically and remaining 12 cases by means of a combination of diagnostic tests. Ultrasonic echogram showed a cytic mass in 10 out of 11 cases examined. 5)According to the classification by Todani et al, of 17 cases in which the type of cyst was confirmed, 16 were type I and the other one was type V. Liver biopsy was available in 17 cases, of which 4 showed macronodular cirrhosis, and another 4 cases showed mild fibrosis and cholestasis. 6)Prior to early 1980, Roux-en-Y choledochocystojejunostomy was performed(4 cases). After then, primary excision was followed by choledocho-or hepaticojunostomy in Roux- en-Y fashion (13 cases), because ascending cholangitis had been known to be sometimes a pstoperative complication after internal drainage only. 7) The postoperative course was uneventful in 16 cases; 2 patients died, one from sepsis and one from bile peritonitis.
Key Words: Biliary cyst

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