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Objective The objective of our study was to evaluate ultrasound images of pediatricpatients with choledochal cyst perforation and establish imaging findings that can be used as the basis for timely surgical intervention.Materials and methods Our study group was composed of 23 pediatric patients who presented with various symptoms of acute abdomen and were admitted to our institution between 1996 and 2013.All had undergone preoperative ultrasound examination and had a final diagnosis of choledochal cyst perforation that was confirmed at exploratory laparotomy.The imaging and surgical data were reviewed and analyzed retrospectively.