Diagnosis and management of giant choledochal cysts: Complexities compared to smaller cysts

Background: This study presents our 11-year surgical experience with choledochal cysts (CDC), focusing on the complexity in the diagnosis and management of large-size CDCs. Methods: Medical records of 70 patients who underwent surgery for CDC between 2000 and 2011 were retrospectively reviewed. Of them, ten patients were found with cyst size >10 cm (group A), and we compared the differences in the clinical presentation, radiological diagnosis and surgical management with those with cysts ≤10 cm in size (group B). Results: Abdominal pain and lump were noted in all group A patients, but only 67 % and 14 % in group B patients, respectively. Sixty percent of group A, but only 14 % of group B patients, had a triad of abdominal pain, mass and jaundice. Cholangitis was more common in group A patients. Most of group B patients were correctly diagnosed with ultrasound alone, but misdiagnosis occurred more frequently in group A. Magnetic resonance cholangiopancreatography correctly achieved the diagnosis in all. Operative time (5 vs. 3 h) and blood loss (300-500 vs. 50-100 mL) were more in group A in comparison to group B. Conclusions: The clinical presentation and surgical management of giant choledochal cysts differ from their smaller counterparts. Diagnostic dilemma was common with giant CDC especially with ultrasound and CT. © 2013 Indian Society of Gastroenterology.