Congenital choledochal cysts.

Cystic dilation of the common bile duct is a rare congenital anomaly. The cases of two patients, 2 1/2 and 18 years old, respectively, illustrate the difficulty in preoperative diagnosis, as well as the value of long-term postoperative follow-up. Ascending cholangitis developed in one of the patients after a Roux-en-Y cystojejunostomy nine years after operation. A follow-up of three years after cystoduodenostomy and 14 years after a hepaticojejunostomy is reported. In infants and small children, a cystoduodenostomy is usually done; otherwise, cystojejunostomy should be the preferred initial operation. Excision may be attempted if the cyst is very small, and in selected cases.