An audit of Complicated Choledochal Cysts- 15-years' experience at a tertiary care center

Purpose Complicated choledochal cysts (CDC) have a variable presentation, and their management differs from an uncomplicated CDC. They are infrequently reported. We present our 15 years of experience in the management of complicated CDC. Methodology We reviewed the data of patients with CDCs managed at a tertiary level center from 2005 to 2020 from a prospectively maintained database. Results Of 215 patients with CDC, 123 patients presented with complicated CDC. The median age of complicated CDC was 31 years with a female preponderance (62.6%). The most common type of CDC associated with complications was type I (69.1%), followed by type IVA (29.3%). The Complicated CDC was presented as cholangitis with or without cystolithiasis ( n = 45), cystolithiasis and hepatolithiasis( n = 44), malignancy( n = 10), complications associated with incomplete cyst excision ( n = 10), acute pancreatitis ( n = 8), chronic pancreatitis( n = 8), portal hypertension ( n = 6), spontaneous rupture ( n = 4), gastric outlet obstruction ( n = 1). These patients were managed as a one-stage approach (52.03%) and a two-stage approach (47.96%). On univariate and multivariate analysis, increasing age, prolonged duration of symptoms, and presence of abnormal pancreaticobiliary ductal junction (APBDJ) were significantly associated with complicated CDC. Conclusion The management of complicated CDC varied depending on the associated pathology, many of them required a staged approach. Increasing age, prolonged duration of symptoms, and presence of APBDJ were significantly associated with complicated CDC.