Muhammad Asif Qureshi, Muhammad Saleem, Mehmood Shaukat.
Choledochal cyst: assessment of the magnitude of problem as seen in a paediatric surgical unit (a single center 8 years experience)..
Pak Paed J Jan ;33(3):179-84.

Background: Choledochal cyst is not an uncommon condition in Pediatric Surgical practice. Its diagnosis is frequently missed. At times even diagnosed cases are mismanaged at various levels of health care and delivery system due to lack of awareness of the potential consequences both in the general public and the primary health care providers. Most patients presenting to a pediatric surgical unit have a long history of symptomatic treatment and a battery of non-yielding investigations. This study, with a large number of patients, reflects the magnitude of the problem as it is seen in a pediatric surgical unit and provides pointers for a better approach towards precise diagnosis and optimal management. Objectives: Identifying delay in diagnosis at various levels and highlighting the significance of various clinical features for diagnosis in infants and children. Methods: A total number of 47 patients falling in pediatric age group have been studied. Ultrasonography has been used as the main diagnostic tool. This is a prospective, descriptive, non interventional study extending over a period of 8 years. Results: It is the second most common disorder of hepatobiliary system in children presenting to our unit, females are in a leading majority. Most of the patients (48.93%) fall in an age group between 2-5 years. Jaundice, fever, hepatomegaly and acholic stools are the leading symptoms under 2 years of age and abdominal pain over 2 years, all with significant p-values. All patients have received (100%) some treatment from general practitioners. Only 2.1% had a near correct diagnosis. Ultrasonography has a high yield of correct diagnosis in experienced hands. Our radiologists, having good experience in pediatric radiology had a 97.5% correct diagnosis. A standard operative procedure of high excision of the extra hepatic bile ducts with Roux-en-Y hepaticojejunostomy at the level of liver hilum, performed in 89.3% of the patients, has excellent results; overall disease specific complication rate is 19.1%. Conclusion: There is a definite delay in diagnosis probably directly attributable to lack of awareness of the disease at primary health care level. There is also a definite delay in referral, increasing the rate of complications, which again perhaps is attributable to the lack of awareness. High index of suspicion should be raised in children with recurrent abdominal pain and jaundice and a simple ultrasonography in experienced hands can be diagnostic.

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