Bile Peritonitis Due To Choledochal Cyst Perforation In Infants

ABSTRACT

Choledochal cyst is rare in the Western countries, but common in the Oriental countries. The reported complicatioins of choledochal cyst are ascending cholangitis, recurrent pancreatities, progressive biliary cirrhosis, portal hypertension, stone in the cyst, and malignant in the biliary tract. Bile peritonitis secondary to rupture is one of the rarest complications of choledochal cyst, and its reported incidence was 1.8% (Yamaguci, 1980) to 18% (Karnak et al, 1997). The exact cause of perforation of choledochal cyst is unknown, but an anomalous arrangement of the pancreatobiliary ductal system with a long common channel may contribute to the formation of choledochal cyst and even perforation of cyst.Authors reviewed 4 cases (14.2%) of bile peritonitis among 28 cases of choledochal cyst in infants from Jan. 1983 to Jan. 1998. Their ages ranged from 6 months to 3 years and three of them were female. Abdominal distension, pain, and vomiting were common symptoms, and clinical jandice and palpable mass were present in one case. Pre-operative laboratory investigations showed elevated serum bilirubin, serum AST and serum ALT in 3 cases, and elevated serum amylase in one case. The perforation sites were located on the common bile duct at its junction with the cystic duct in 2 cases, distal cyst wall in 1 case and left hepatic duct at its junction with cyst in 1 case. The types of choledochal cysts according to Todani's classification (1977) were as follows;Type IVa was in 3 cases, type I was in 1 case. The results of operative cholangiogram according to new Komi's classification (1992) were as follows;Type Ia was 2 cases, type IIb 1 case, and type III 1 case. One stage primary cyst excision and hepaticojejunostomy(Roux-en Y type) was done in 3 cases, and two staged operation in 1 case. All patients have recovered unevenfully after surgery and discharged at post -operative 9.8th day averagely. Authors concluded that the primary choledochal cyst excision with biliary recontinuity was a safe surgical procedure in ruptured choledochal cyst in infants.