Dr Aniruddha Bhagwat MB MS MCh Dept Of Pediatric Surgery Dr D Y Patil Medical College Hospital and Research Center PCMC Pune Nomenclature Clinical Presentation Older children 210 years ID: 1043190
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1. Choledochal cysts in children- A 5 year experienceDr. Aniruddha Bhagwat MB, MS, MChDept. Of Pediatric SurgeryDr. D Y Patil Medical College Hospital and Research Center, PCMC, Pune
2. Nomenclature
3. ClinicalPresentationOlder children 2-10 yearsF>MAbdominal massJaundicePain +/- Fever cholangitisUncommonSpontaneous cyst ruptureStone formation in cyst or G.B.Infection – cyst wall inflammation, fibrosis, infection
4. Differential Diagnosis
5. Todani ClassificationI Dilatation of extrahepatic bile duct onlyIA CysticIB SaccularIC FusiformII DiverticulumIII CholedochoceleIV Intra and extra hepatic duct dilatationIV a Intra and extrahepatic cystsIV b Multiple extrahepatic cystsV Caroli’s disease
6. Surgical Principles Treatment modalitiesComplete cyst excision + P-D/H-J with Roux en Y +/- Lillie’s valveOlder Partial excision + C-D/ C-JLaparoscopicRoboticERCP with sphincterotomyLiver Transplantation
7. Inflamed or infected cysts AtrophyMetaplasiaPolypsAdenocarcinoma
8. Physiologic disturbancesPD more physiologicSphincter of Oddi bypassed and non functional. (HJ/PD)G.B removed. (HJ/PD)Storage of bile and release on stimulation by CCK-PZBiliary gastric reflux –dyspepsia, alkaline gastritis, erosionsPancreato-biliary refux- anastomotic strictures, recurrent cholangitis, fever, jaundiceBiliary pancreatic refluxPancreatitis
9. December 2014 to January 2020Age wise distributionCholedochal CystsIncidenceAgeNumber of casesIncidence %Less than 1 yr746.682 – 5 yrs426.666-10 yrs213.3311-16 yrs213.3315 cases of Choledochal cysts were operatedAll were below 16 years ageCE + PD (6)ERCP +sphincterotomy + stenting (1)CE + HJ + Roux (8)
10. Investigations:HemogramRFTLFTCoagulation profileUrine REH-H-H markersCovid 19 RT PCRStool REChest X-rayUSG abdomenCECT abdomenMRCPTc99m Hepato-biliary scintiscan DISIDAERCPCholangiogram
11. MRCP
12.
13. ERCP
14. Type 1 (12=80%) Type 5 excludedType 2 (1 =6.67%) One case of type 3 excludedType 4 (2 =13.33%) Left PVO, Portal HT, ?Forme fruste cyst with CBD diln, perforation, bile peritonitisResults-Mean age at presentation 4.12+/- S.D.M:F 1:1Mean time to oral feeds 5 +/- 1d Mean in-hospital stay 11 +/-3 dMean duration of ADK drain 5 dMean antibiotic Tx duration 7 +/-2 dComplications-One anastomotic leak. Tx conservativelyOne SSINo deathsNo HaemorrahageNo Intestinal obstruction adhesions/kinking/mesenteric herniation/ intussusception Pancreatic injury pseudo-aneurysm
15. Thank you for patient listening.