Choledochal Cysts Clinical Presentation

Updated: Jul 01, 2020
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History and Physical Examination

History

The patient history varies according to the age at presentation. Choledochal cysts can present dramatically in infancy. The clinical manifestations in older children and adults are more protean.

Infants

Infants frequently present with obstructive jaundice and acholic stools. In early infancy, this may prompt a workup for biliary atresia. [23, 24] In addition, infants with choledochal cysts often have a palpable mass in the right upper quadrant of the abdomen, accompanied with hepatomegaly.

Children

Children diagnosed after infancy typically have a clinical picture of intermittent biliary obstruction or recurrent bouts of pancreatitis. Those with a biliary obstructive pattern can still present with a palpable right upper quadrant mass and jaundice.

Children whose primary manifestation is pancreatitis may pose some difficulty in arriving at the correct diagnosis. These patients frequently have only intermittent attacks of colicky abdominal pain. Biochemical testing reveals elevated amylase and lipase concentrations, which lead to the proper diagnostic workup.

Adults

Adults with choledochal cysts can present with one or more severe complications. Frequently, adults with choledochal cysts complain of vague epigastric or right upper quadrant pain and can develop jaundice or cholangitis.

The most common symptom in adults is abdominal pain. A classic triad of abdominal pain, jaundice, and a palpable right upper quadrant abdominal mass has been described in adults with choledochal cysts but is found in only 10-20% of patients. The majority of patients only have one or two symptoms of the triad.

Physical examination

A right upper quadrant mass may be palpable. This is observed more frequently in infancy and early childhood.

Patients who develop pancreatitis present with nonspecific midepigastric or diffuse abdominal pain.