BACKGROUND: Choledochal cyst is a rare congenital anomaly manifesting as cystic dilatation of the biliary tree. This study presents our 5-year experience with giant choledochal cyst in adolescents and adults, focusing primarily on its clinical presentation, operative challenges, and pragmatic solutions.
METHODS: A retrospective observational study was conducted on 58 adolescent and adult choledochal cyst patients who were managed at a tertiary care hospital. Giant choledochal cyst is defined as cyst with a maximum diameter of ≥ 10 cm. Demographic profile, clinical presentation, and surgical outcome of these patients were analyzed.
RESULTS: A total of 12 patients with giant choledochal cyst were managed in our department in a duration of 5 years. The median age of patients with giant choledochal cyst was 20 years (range, 13-30 years) and male to female ratio was 1:2. Giant choledochal cysts were more symptomatic and 8 out of 12 presented with classic triad of abdominal pain, mass, and jaundice. One patient with giant choledochal cyst had metastatic cholangiocarcinoma. Eleven patients underwent surgical cyst excision. Surgery of the giant cyst was challenging and required technical modifications for safe excision.
CONCLUSIONS: Giant choledochal cyst is an unusual entity that is rarely encountered beyond first decade of life. These cysts pose unique surgical challenges and require modification of the standard operative technique.

Despite the developmental toxicity reported in animals, few epidemiologic studies have investigated the potential effects of prenatal exposure to pyrethroid pesticides (PYRs) on fetal growth. A birth cohort study was conducted to examine the association between prenatal exposure to PYRs and birth outcomes, and a nested case-control study was conducted in this cohort to evaluate the effects of PYR on congenital defects. The assessment of PYR exposure was based on self-reported household pesticide use and urinary PYR metabolite levels. We found that pregnant women in this region were ubiquitously exposed to low-level PYRs, although few reported household pesticide use. Women who often ate bananas or cantaloupes had a higher level of urinary 3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DBCA), and the number of fruit types consumed by pregnant women was positively related to the concentrations of 3-phenoxybenzoic acid (3PBA) and total PYR metabolites (P < 0.05). Increased urinary 4-fluoro-3-phenoxybenzoic acid (4F3PBA), DBCA, and total PYR metabolites were associated with increased birth weight, length, and gestational age, and with decreased risk of small for gestational age (SGA) and/or premature birth. However, maternal household pesticides use was related to congenital anomalies. Thus, although prenatal exposure to low-dose PYRs promoted the fetal growth, the beneficial effects of fruit intake may outweigh the adverse effects of pesticide exposure. This study provided us an insight into the biological mechanisms for the effect of prenatal PYR exposure on fetal development, and suggested that further investigations in a larger study population with low-dose PYR exposure is needed.