Choledochal cyst. Etiological considerations and surgical management in 22 cases.

In a 14-year period from 1962 to 1976, there were 22 cases of choledochal cyst treated by two different approaches: choledochocystenterostomy to the duodenum in three and to the jejunum in a Roux-en-Y operation in four cases, and excision of the cyst with hepaticojejunostomy in 14 and with end-to-end anastomosis of the common bile duct in one case. There was one death in each group. In five cases, direct cholangiography, either operative or endoscopic, demonstrated a reflux of the contrast material from the biliary system to the pancreatic duct. In four cases, the amylase level of the cystic content was elevated, ranging from 182 to 50,820 Somogyi units. A reflux of the pancreatic juice into the biliary system was thought to be a possible cause of choledochal cyst. Excision of the cyst with hepaticojejunostomy in a Roux-en-Y operation seems to be the treatment of choice from the aspects of cholangitis, malignant change, and termination of the pancreatic reflux to the biliary system.