Association Among Cystic Volume, Intracystic Pressure, and Histopathological Changes in the Liver in Patients With Choledochal Cyst

Fatima Tul Jannat; K M Didarul Islam; Mahmud Hasan Mostofa Kamal; Bishnu Pada Dey; Noor Mahammad; Umme Habiba Dilshad Munmun; Jannatul Nayeema Tonny; Md Shahinur Rahman; Md Ruhul Amin; A K M Zahid Hossain

doi:10.7759/cureus.50208

Association Among Cystic Volume, Intracystic Pressure, and Histopathological Changes in the Liver in Patients With Choledochal Cyst

Cureus. 2023 Dec 9;15(12):e50208. doi: 10.7759/cureus.50208. eCollection 2023 Dec.

Affiliations

¹ Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
² Department of Pediatric Surgery, Nobojatok-Shishu and General Hospital, Dhaka, BGD.
³ Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
⁴ Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
⁵ Department of Pediatric Surgery, Armed Forces Medical Institute, Dhaka, BGD.
⁶ Department of Pediatric Surgery, Rangpur Medical College and Hospital, Rangpur, BGD.

Abstract

Background Choledochal cyst is a congenital cystic dilatation of the biliary tree. Various aspects of pathophysiology are unclear, particularly with reference to intracholedochal cystic pressure (ICCP) and liver histopathology. This study aimed to determine the relationship among cystic volume, ICCP, and histopathological changes in the liver in patients with choledochal cysts. Methods This cross-sectional study was carried out among 21 patients diagnosed with choledochal cysts, who attended the Department of Pediatric Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2021 to August 2022. Cystic volume was measured pre-operatively using ultrasonography, while ICCP was measured per-operatively with a pressure gauge. Liver histology was assessed through an intraoperative liver biopsy and graded using the meta-analysis of histological data in viral hepatitis (METAVIR) scoring system. The data were analyzed using SPSS version 25.0 (IBM Corporation, Armonk, New York). Frequency and percentages were calculated to present categorical variables, and for quantitative variables, mean, standard deviation (SD), median, and interquartile range (IQR) were calculated. Fisher's exact tests were performed to determine the association between cystic volume, ICCP, and the grading of hepatic fibrosis. A p-value of <0.05 was considered statistically significant. Results The age of the patients ranged from 1 to 12 years, with a mean of 5.0±3.4 years. The male-to-female ratio was 1:4.3. Type I cysts were the most prevalent (71.4%). The median and IQR for cystic volume were 3.4 ml and 1.1-8.2 ml, respectively. The median and IQR for ICCP were 7.46 mmHg and 4.67-9.33 mmHg, respectively. The most frequent grade of fibrosis was F1 (38.1%), followed by F2 (23.8%) and F3 (23.8%). A negative relationship between cystic volume and ICCP was observed, which was statistically significant (p=0.008). A positive relationship was also observed between ICCP and the grading of liver fibrosis, which was statistically significant (p=0.002). Although a negative correlation between cystic volume and grading of liver fibrosis was noted, it was not statistically significant (p=0.198). Conclusions This study reveals significant associations between cystic volume, ICCP, and the grading of liver fibrosis in patients with choledochal cysts. Smaller volume cysts may exhibit higher ICCP, resulting in more pronounced fibrotic changes in the liver.

Keywords: choledochal cyst; cystic volume; intracystic pressure; liver fibrosis; metavir.