pediatrics
Duodenal Obstruction
Choledochal cyst
A choledochal cyst may obstruct the duodenum by extrinsic pressure. The incidence ranges from approximately 1 in 100,000 people in the United States or Europe to 1 in 13,000 in Japan ( References ). Over half of reported cases occur in Japan. There is some evidence that the incidence of choledochal cysts is increasing. Infants with choledochal cyst classically present with a triad of abdominal pain (a very difficult finding to infer in the neonate), right upper quadrant mass, and jaundice. If the cyst is large, it may also manifest with variable degrees of duodenal obstruction. Neonates can present with Neonatal Cholestasis . In some cases, pancreatitis is an associated finding. Choledochal cyst is most commonly diagnosed by ultrasonography. These cysts can be further defined by using magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasonography. Treatment of choledochal cyst is surgical and requires complete excision of the cyst because of the high risk (20 to 30%) of developing cancer in the cyst remnants ( References ). The surgical procedure most commonly used is a Roux-en-Y hepaticojejunostomy. This procedure is typically done laparoscopically. Some recent studies have noted that the outcome may be enhanced with robotic-assisted surgery. 