Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Korean J Radiol. 2022 Feb;23(2):271-279. doi: 10.3348/kjr.2021.0169. Epub 2022 Jan 4.
To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children.
Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test.
Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever ( < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells ( = 0.004), C-reactive protein ( < 0.001), and serum amylase ( = 0.002), and low levels of albumin ( < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites ( < 0.001). In the subgroup of patients who had ascites, a large amount of ascites ( = 0.001), increase in the amount of ascites in a short time ( < 0.001), complex ascites ( < 0.001), and perihepatic pseudocysts ( < 0.001) were more common in the perforated group than in the non-perforated group.
Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.
比较儿童穿孔性和非穿孔性胆总管囊肿的临床和影像学表现。
2000 年至 2019 年期间，共纳入 14 例穿孔性胆总管囊肿患儿（平均年龄±标准差，1.7±1.2 岁，穿孔组）和 204 例非穿孔性胆总管囊肿患儿（3.6±3.8 岁，非穿孔组）。所有患者均在超声、CT 或磁共振胰胆管成像后行胆总管囊肿切除。分析患者的人口统计学、临床症状、实验室检查结果、影像学表现和转归等相关数据。采用 Mann-Whitney U 检验和 Fisher 确切概率法比较统计学差异。
胆总管囊肿穿孔仅发生于 4 岁以下儿童。穿孔组发热等急性症状更为常见（<0.001）。白细胞计数升高（=0.004）、C 反应蛋白升高（<0.001）和血清淀粉酶降低（=0.002），以及白蛋白降低（<0.001）与穿孔组显著相关。14 例穿孔性胆总管囊肿患儿均有腹水，而非穿孔组仅 16%（33/204）有腹水（<0.001）。在有腹水的患者亚组中，大量腹水（=0.001）、短时间内腹水增加（<0.001）、复杂腹水（<0.001）和肝周假性囊肿（<0.001）在穿孔组更为常见。
与非穿孔性胆总管囊肿相比，穿孔性胆总管囊肿患儿具有特征性的临床和影像学表现。在有胆总管囊肿的年幼患儿中，对于有急性症状、实验室异常和特征性腹水表现的病例，应鉴别穿孔。
