Choledochal cyst: A challenging diagnostic and therapeutic entity in low-resource settings

Abstract

Background Choledochal cyst is an uncommon congenital biliary tract abnormality of unknown etiology. Its classical symptoms are jaundice, abdominal pain, and right upper quadrant mass. However, the disease may present with a vague and non-specific chronic abdominal discomfort. Delay in diagnosis and management may increase the risk of complications particularly the malignancy, which can directly affect the prognosis and outcome. Complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy through the open surgical intervention or laparoscopic procedure is the mainstay of treatment. Case Presentation A 14-year-old male was presented to our hospital complaining of vague abdominal pain for 5 years. The radiologic imaging showed the features of a type IVa choledochal cyst. He underwent complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy. Although the bile leakage occurred as a complication of the procedure, our team best managed the patient in the post-operative period until full recovery. Discussion The Choledochal cyst was first described by Vater, which is a congenital anomaly that sometimes may remain asymptomatic till adulthood. Surgical intervention is the mainstay of treatment. However, postoperative complications including bile leakage need a close follow-up of the patient. Conclusion Diagnostic delay (antenatal and postnatal) and non-specific symptoms will mask the real feature of the disease, especially in low-resource settings. Technical facilities and professional care of the patient may preclude complications.

Choledochal Cysts in Female Adult: Diagnostic Pitfall and Conservative Therapy for Bile Leak

“…Type IV (10-20% of cases) is multiple cysts in the intrahepatic or extra-hepatic ducts. Type V (1% of cases) is characterized by single or numerous intrahepatic cysts (Caroli's disease) 7,8 .…”

“…Another additional examination is Endoscopic retrograde cholangiopancreatography (ERCP) which helps diagnose abnormalities in the distal duct. Magnetic cholangiopancreatography (MRCP) can replace ERCP, which is non-invasive and has high accuracy 7 .…”

“…Management of the choledochal cyst is highly dependent on the type of duct. The standard management for type IA Todani choledochal cysts is complete cyst excision and cholecystectomy followed by Roux n Y hepaticojejunostomy 7 . Type I and type IV choledochal cysts are the highest risk of becoming malignant, thus wide cyst excision, cholecystectomy, and Roux n Y hepaticojejunostomy are performed to reduce the risk 11 .…”

“…Common complications are bile leakage (7%), anastomotic strictures, intrahepatic cholelithiasis, pancreatitis, obstruction due to adhesions, and malignancy. Management of this patient is based on previous studies by Suleiman and Hakimi 7,11,12 .…”

“…Ultrasonography (USG) is used as an initial examination of the choledochal cyst, followed by a computed tomography (CT) scan. CT scan can show the cyst type, its adhesions with surrounding organs, and staging if there is a possibility of malignancy that increases with age 7 . In first case report, a type 1A Todani choledochal cyst with obstructive jaundice and chronic abdominal pain was found in 21 years old female patient.…”