الفهرس 
Choledocal cyst in infants and children: clinical presentation and complications
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Abstract
Choledochal cysts (CC) are congenital cystic dilation of extrahepatic duct, intrahepatic duct, or both that may result in significant morbidity and mortality, unless identified early and managed appropriately.Aim of work:Identification of the clinical presentation of CC in different age groups of children and detection of the frequency of pre and postoperative complications.Patients and methods:This observational retrospective study included 39 children diagnosed as CC presenting to the Pediatric Hepatology Unit, Cairo University during the time period from 2009-2016. Data collected from the patients’ files included: medical history, examination, laboratory and radiological findings, surgical procedure, outcome and complications. Results:Female to male ratio was 4.6: 1. The median age of onset of symptoms was 9 months (1 day - 78 months). The most common presenting symptom was jaundice in 79.4% of patients, and abdominal pain in 43.5%. Jaundice was significantly more frequent in younger patients being present in all patients with age of disease onset less than 3 months. Meanwhile, abdominal pain was more common in patients with age of onset more than 3 months. About 66% of patients had elevated total bilirubin, 71.7% had elevated ALT and 76.9% had elevated AST. Radiological imaging revealed that 23 patients (58.9%) had type I CC, 14 patients (35.9%) had type IV, 1 patient had type II CC (2.6%) and 1 patient had type V CC (2.6%). The median age of operated children at the time of operation was 17 months. Cyst exsicion was done using Roux en-y-hepaticojujenostomy in 73.7% of patients. Complications were reported in 9 patients (23%). Postoperatively, recurrent cholangitis was reported in 10.2%. Biliary stricture was reported in 5.1% of patients and was treated by insertion of stent by ERCP. Pancreatitis and gallstones were reported in 2.5% each. Conclusion: The most common presenting symptom of CC in children is jaundice followed by abdominal pain not the known classic triad.Jaundice is more frequent in younger patients with CC while abdominal pain is more common in older patients. The most common CC type in children is type I followed by type IV. Complications are not uncommon in children with CC (23%) with cholangitis is the main reported complication.