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CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2023; 06(02): 154-157
DOI: 10.1055/s-0042-1759682
Case-in-Discussion (Missed Diagnosis)

Spontaneous Rupture of Choledochal Cyst: A Rare Presentation

P. Juvaina 
1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
,
K.T. Aleena
1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
,
Arakkal Riyaz
2   Department of Paediatric Gastroenterology, KMCT Medical College, Mukkam, Kozhikode, Kerala, India
,
E. Devarajan
1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
,
P. Ranjit
3   Department of Pediatric Surgery, Govt. Medical College, Kozhikode, Kerala, India
,
E.R. Rani Jyothi
4   Department of Pathology, Govt. Medical college, Kozhikode, Kerala, India
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Abstract

Choledochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.

Keywords

choledochal cyst - rupture - biliary peritonitis


Publikationsverlauf

Artikel online veröffentlicht:
09. Januar 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Hewitt PM, Krige JE, Bornman PC, Terblanche J. Choledochal cysts in adults. Br J Surg 1995; 82 (03) 382-385
    CrossrefPubMedGoogle Scholar
  • 2 Belli G, Rotondano G, D'Agostino A, Iannelli A, Marano I, Santangelo ML. Cystic dilation of extrahepatic bile ducts in adulthood: diagnosis, surgical treatment and long-term results. HPB Surg 1998; 10 (06) 379-384 , discussion 384–385
    CrossrefPubMedGoogle Scholar
  • 3 Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am J Surg 1993; 165 (02) 238-242
    CrossrefPubMedGoogle Scholar
  • 4 Lipsett PA, Pitt HA. Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg 2003; 10 (05) 352-359
    CrossrefPubMedGoogle Scholar
  • 5 Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 1980; 140 (05) 653-657
    CrossrefPubMedGoogle Scholar
  • 6 Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 2003; 10 (05) 340-344
    CrossrefPubMedGoogle Scholar
  • 7 Moss RL, Musemeche CA. Successful management of ruptured choledochal cyst by primary cyst excision and biliary reconstruction. J Pediatr Surg 1997; 32 (10) 1490-1491
    CrossrefPubMedGoogle Scholar
  • 8 Shimura H, Tanaka M, Shimizu S, Mizumoto K. Laparoscopic treatment of congenital choledochal cyst. Surg Endosc 1998; 12 (10) 1268-1271
    CrossrefPubMedGoogle Scholar
  • 9 Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg 2004; 91 (12) 1538-1548
    CrossrefPubMedGoogle Scholar
  • 10 Lee KF, Lai ECH, Lai PBS. Adult choledochal cyst. Asian J Surg 2005; 28 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 11 Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Spontaneous rupture of choledochal cyst: an unusual cause of acute abdomen in children. J Pediatr Surg 1997; 32 (05) 736-738
    CrossrefPubMedGoogle Scholar
  • 12 Chaudhary A, Dhar P, Sachdev A. Reoperative surgery for choledochal cysts. Br J Surg 1997; 84 (06) 781-784
    PubMedGoogle Scholar
  • 13 Kaneko K, Ando H, Watanabe Y. et al. Secondary excision of choledochal cysts after previous cyst-enterostomies. Hepatogastroenterology 1999; 46 (29) 2772-2775
    PubMedGoogle Scholar
  • 14 Samavedy R, Sherman S, Lehman GA. Endoscopic therapy in anomalous pancreatobiliary duct junction. Gastrointest Endosc 1999; 50 (05) 623-627
    CrossrefPubMedGoogle Scholar
  • 15 Maheshwari M, Parekh BR, Lahoti BK. Biliary peritonitis: a rare presentation of perforated choledochal cyst. Indian Pediatr 2002; 39 (06) 588-592 Accessed April 9, 2022
    PubMedGoogle Scholar
  • 16 Tanaka M, Shimizu S, Mizumoto K. et al. Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction. Surg Endosc 2001; 15 (06) 545-552
    CrossrefPubMedGoogle Scholar
  • 17 Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM. Variation in management based on type of choledochal cyst. Am J Surg 1991; 161 (05) 612-615
    CrossrefPubMedGoogle Scholar
  • 18 Elton E, Hanson BL, Biber BP, Howell DA. Dilated common channel syndrome: endoscopic diagnosis, treatment, and relationship to choledochocele formation. Gastrointest Endosc 1998; 47 (06) 471-478
    CrossrefPubMedGoogle Scholar
  • 19 Adamek HE, Schilling D, Weitz M, Riemann JF. Choledochocele imaged with magnetic resonance cholangiography. Am J Gastroenterol 2000; 95 (04) 1082-1083
    CrossrefPubMedGoogle Scholar
  • 20 Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Nakagohri T, Ochiai T. Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery 1999; 126 (05) 939-944
    CrossrefPubMedGoogle Scholar
  • 21 Thambi Dorai CR, Visvanathan R, McAll GL. Type IVa choledochal cysts: surgical management and literature review. Aust N Z J Surg 1991; 61 (07) 505-510
    CrossrefPubMedGoogle Scholar