An impressive choledochal cyst and its surgical resection

Nhu Thao Nguyen Galván, Kayla Kumm, Dor Yoeli, Ellen Witte, Michael Kueht, Ronald Timothy Cotton, Abbas Rana, Christine A. O'Mahony, John A. Goss

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction Choledochal cysts are rare congenital dilations of the biliary tree that can present with non-specific symptoms such as abdominal pain, jaundice, cholelithiasis and pancreatitis. Although most commonly identified in children, they can be found in the adult population. However, because of the non-specific symptoms, this diagnosis may be difficult to make in the adult. A physician therefore must keep this diagnosis within their differential, as it may arise in an unexpected patient population who may present with a convoluted work up. Case presentation In this report, we present the case of a 50-year-old African American woman with recurrent cholelithiasis, cholangitis and eventually obstructive jaundice despite undergoing a laparoscopic cholecystectomy six years prior. Her only work up at that point was a right upper quadrant ultrasound revealing gallbladder sludge, which led to her cholecystectomy. It was the persistence of her symptoms—abdominal pain, cholangitis and obstructive jaundice—previously attributed to chronic cholecystitis and choledocholithiasis that warranted further work up. After multiple physician visits, she was referred to our academic center after an ERCP was performed and she was found to have a dilation of her common bile duct consistent with a choledochal cyst. Furthermore, the ERCP identified multiple bile duct stones within the cyst. This was not identified on her original ultrasound or prior ERCPs. The patient underwent a complete cyst excision with Roux-en-Y hepaticojejunostomy and did well post-operatively. Discussion This report illustrates how choledochal cysts can be an elusive diagnosis, but may present with repeated infections, recurrent biliary stones, and biliary obstruction despite a cholecystectomy. Had she an MRCP prior to her cholecystectomy, she would likely have avoided multiple surgeries, and years of persistent symptoms. Choledochal cysts are associated with an increased risk of biliary malignancy and therefore cyst excision is the standard of care. Conclusion Although rare, physicians need to keep this diagnosis in mind, and be aware of the clinical and imaging findings consistent with a choledochal cyst in order to facilitate appropriate work up, referral and treatment.

Original languageEnglish (US)
Pages (from-to)48-50
Number of pages3
JournalInternational Journal of Surgery Case Reports
Volume33
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Choledochal Cyst
Endoscopic Retrograde Cholangiopancreatography
Cholecystectomy
Cysts
Cholangitis
Cholelithiasis
Physicians
Dilatation
Choledocholithiasis
Cholecystitis
Obstructive Jaundice
Laparoscopic Cholecystectomy
Common Bile Duct
Biliary Tract
Standard of Care
Sewage
Jaundice
Bile Ducts
Gallbladder
Pancreatitis

Keywords

  • Case report
  • Choledochal cyst
  • Choledocholithiasis
  • Endoscopic retrograde cholangiopancreatography or ERCP
  • Hepaticojejunostomy
  • Hepatobiliary surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Galván, N. T. N., Kumm, K., Yoeli, D., Witte, E., Kueht, M., Cotton, R. T., ... Goss, J. A. (2017). An impressive choledochal cyst and its surgical resection. International Journal of Surgery Case Reports, 33, 48-50. https://doi.org/10.1016/j.ijscr.2017.02.034

An impressive choledochal cyst and its surgical resection. / Galván, Nhu Thao Nguyen; Kumm, Kayla; Yoeli, Dor; Witte, Ellen; Kueht, Michael; Cotton, Ronald Timothy; Rana, Abbas; O'Mahony, Christine A.; Goss, John A.

In: International Journal of Surgery Case Reports, Vol. 33, 01.01.2017, p. 48-50.

Research output: Contribution to journalArticle

Galván, NTN, Kumm, K, Yoeli, D, Witte, E, Kueht, M, Cotton, RT, Rana, A, O'Mahony, CA & Goss, JA 2017, 'An impressive choledochal cyst and its surgical resection', International Journal of Surgery Case Reports, vol. 33, pp. 48-50. https://doi.org/10.1016/j.ijscr.2017.02.034
Galván, Nhu Thao Nguyen ; Kumm, Kayla ; Yoeli, Dor ; Witte, Ellen ; Kueht, Michael ; Cotton, Ronald Timothy ; Rana, Abbas ; O'Mahony, Christine A. ; Goss, John A. / An impressive choledochal cyst and its surgical resection. In: International Journal of Surgery Case Reports. 2017 ; Vol. 33. pp. 48-50.
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