Carcinoma Related to Choledochal Cysts with Internal Drainage
Operations
Takuji Todani, Yasuhiro Watanabe, Akira Toki, Naoto Urushihara
Surg Gynecol Obstet 164: 61-64, 1987
Carcinoma arising in a choledochal cyst retained after
enteric drainage is discussed in comparison with primary carcinoma. In our
series. carcinoma developed in eight of 82 patients with choledochal cyst
and three of the eight had secondary carcinoma occurring several years after
enteric drainage. Forty-two similar instances and 235 instances of primary
carcinoma have been reported in Japan. The mean age at detection of carcinoma
in enteric drainage was 35 years old. l5 years less than that of primary
carcinoma. The mean interval between drainage and detection of carcinoma
was ten years. Carcinoma mainly arose from the retained cyst in drainage.
while primary carcinoma developed in either the cyst or gallbladder. The
prognosis was very poor. Almost all patients undergoing enteric drainage
died soon after the detection of carcinoma. This is possibly due to the
delay in diagnosis. Pancreatic juice can easily regurgitate into the choledochus
through an anomalous junction of the pancreatobiliary ductal system. and
enteric drainage causes pancreatic juice in the cyst to become activated
due to the influx of intestinal juice. Therefore. inflammatory changes of
the cyst are accelerated and probably result in carcinoma. Early excision
of the choledochus should be recommended in patients with choledochal cyst
retained after enteric drainage.
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