Choledochal cyst- unusual presentation in the adult phase: Case report

Victor Vinicius Monteiro Lins De Albuquerque,Frank Pinheiro De Macedo,Ketlen G Costa,Zuriel Rodrigues Seixas Nunes,Rubem A Da Silva Junior

doi:10.1016/j.ijscr.2020.03.014

Victor Vinicius Monteiro Lins De Albuquerque, Frank Pinheiro De Macedo + Show 3 more

Open Access

https://doi.org/10.1016/j.ijscr.2020.03.014

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Abstract

IntroductionBile duct cysts are congenital malformations characterized by bile duct dilatation with intra and/or extrahepatic localization. About 80% of cases are diagnosed in childhood, so their presentation in adults is rare and repeatedly associated with complications. Presentation of caseA 38-year-old female patient complained of severe abdominal pain for one month, with no associated cholestatic signs. She underwent abdominal ultrasonography that showed cholelithiasis with extrahepatic bile duct dilatation and underwent cholangiography (MRI), which revealed fusiform dilatation of the proximal portion of the hepatocholedochal, compatible with choledochal cyst. DiscussionIn adult patients, clinical manifestations are usually nonspecific, and the diagnosis is established by medical imaging. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard diagnostic today. Treatment with better prognosis consists of total cyst resection with hepaticojejunal anastomosis and intestinal transit reconstruction with Roux-en-Y. ConclusionBile duct cysts are a rare condition in adults. Currently, increasing access to more accurate medical imaging enables early diagnosis, contributing to the use of therapeutic methods in appropriate time, avoiding development of complications.

Highlights

Bile duct cysts are congenital malformations characterized by biliary duct dilatation with an intra and/or extrahepatic localization
Around 80% of cases are diagnosed in childhood, thence, the presentation in adults is rare and it is repeatedly associated with complications such as cholangitis, stone formation, cyst rupture, secondary biliary cirrhosis, obstructive jaundice and malignancy [1,3,9,10]
In adults the presentation can be difficult with nonspecific abdominal pain, under consideration the classic triad observed in about 25% of cases for this group [1,3,10,11]

Summary

INTRODUCTION

Bile duct cysts are congenital malformations characterized by bile duct dilatation with intra and/or extrahepatic localization. About 80% of cases are diagnosed in childhood, so their presentation in adults is rare and repeatedly associated with complications. PRESENTATION OF CASE: A 38-year-old female patient complained of severe abdominal pain for one month, with no associated cholestatic signs. She underwent abdominal ultrasonography that showed cholelithiasis with extrahepatic bile duct dilatation and underwent cholangiography (MRI), which revealed fusiform dilatation of the proximal portion of the hepatocholedochal, compatible with choledochal cyst. DISCUSSION: In adult patients, clinical manifestations are usually nonspecific, and the diagnosis is established by medical imaging. Increasing access to more accurate medical imaging enables early diagnosis, contributing to the use of therapeutic methods in appropriate time, avoiding development of complications

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