To the Editor.—Rattner et al1 have stated that "mucosal abnormalities have been described only in adults," suggesting that choledochal cysts in children might represent a different pathologic entity from those found in adults.
Our review of 19 cases of choledochal cysts in children reported that the cyst walls "showed fibrous tissue, fragmented elastic fibers and scattered inflammatory cells within granulation tissue. Epithelium was absent or only present as focal remains."2 In this series, infants younger than 1 year of age had associated atresias of the common duct, cystic duct, and gallbladder, suggesting that these patients had a congenital malformation or a perinatal noxious insult. The older children had associated malformations of the pancreatic and common duct junctions, suggesting acquired lesions secondary to this malformation.