Unusual Presentations of Choledochal Cyst: Case Series and Review of Literature (original) (raw)

2014, Indian Journal of Surgery

Congenital cystic dilation of the biliary duct is defined as choledochal cyst (CDC). CDC presenting with the classical triad of abdominal pain, lump, and jaundice is s e e n i n o n l y 6 % c a s e s. C y s t e x c i s i o n w i t h hepaticojejunostomy is the standard treatment worldwide. We hereby report five cases of CDC with unusual presentations (gastric outlet obstruction, cyst perforation, giant cystolithiasis, giant cyst, and mixed type) and discuss the challenges faced during the diagnosis and perioperative management of these cases. diagnosis and management. Herein, we report five cases of CDC who had unusual features on presentation. Case Series Of the 29 cases of CDC managed between January 2009 and December 2013, 5 (17.2 %) cases had unusual presentation. Case 1 A 12-year-old girl presented with history of pain in the abdomen for 2 years and recurrent bilious vomiting for 7-months duration. Upper gastrointestinal endoscopy showed dilated stomach with external compression at the antropyloric region. Subsequently, contrast-enhanced computed tomography (CECT) was done, which showed type I CDC with gastric outlet obstruction (Fig. 1a). On exploration, dilated stomach with a large CDC (10×7 cm) compressing the antropyloric region was present (Fig. 1b). CDC excision with Roux-en-Y hepaticojejunostomy (RYHJ) was performed. Postoperative course was uneventful and patient is doing well after a follow up of two and half years. Case 2 A 16-year-old female presented with complaints of abdominal pain for 2 months. Abdominal ultrasonography (USG) revealed a dilated common bile duct (CBD) suggesting CDC. Though surgery was advised on index admission, patient refused the same due to personal reasons. One month later, she presented with jaundice, fever, epigastric lump, and features of local peritonitis. Liver function test showed raised serum bilirubin, 17.25 mg/dl (normal range 0-1.4 mg/dl) and liver enzymes (serum aspartate transaminase, AST), 174 IU/L