Abstract
Choledochal cyst (CC)—a congenital anomaly of the bile duct—is rare. We report a 28-year-old woman complaining of epigastralgia who was transferred to our hospital. Physical examination revealed severe tenderness to abdominal palpation without symptoms of diffuse peritonitis. Urgent contrast-enhanced abdominal computed tomography indicated the dilated common bile duct (CBD) was perforated, with a presumed diagnosis of perforated CC. Endoscopic external biliary drainage was performed immediately as a bridging procedure to the definitive surgery. Additional evaluations confirmed a type IVa CC, according to Todani’s classification, but no signs of malignancy. Twenty-two days after biliary drainage, laparotomy was performed. A large cystic mass was found in the CBD with a perforated scar on the right-side wall. Because inflammation around the pancreas head was too severe to perform cyst excision safely, the patient underwent subtotal stomach-preserving pancreatoduodenectomy. The postoperative course was uneventful, and the patient was discharged on the 29th postoperative day. Pathologic examination of a specimen showed no malignancy, and the patient has remained well during the 3-year follow-up. Our experience with this case suggests that definitive single-stage surgery for perforated CC in an adult can be performed safely owing to external biliary drainage as a bridging procedure, if manifestation of diffuse peritonitis is not evident.
Highlights
Choledochal cyst (CC) in adults is rare [1], but perforation of CC occasionally has been reported following invasive procedures in or around the common bile duct (CBD) or after trauma [2,3,4]
We review past cases in the literature and discuss the problems associated with management and timing of the definitive surgery for perforated CC in adults
It has been reported that anomalous pancreaticobiliary ductal union (APBDU), which is seen in almost all cases of CC [10, 11], predisposes the patient to risk of carcinoma
Summary
Choledochal cyst (CC) in adults is rare [1], but perforation of CC occasionally has been reported following invasive procedures in or around the common bile duct (CBD) or after trauma [2,3,4]. Case presentation A 28-year-old woman experienced sudden-onset abdominal pain with associated nausea and vomiting during the night. She was transferred to our hospital complaining of severe epigastralgia. The patient’s medical history was Minagawa et al Surgical Case Reports (2015) 1:117 unremarkable Her blood pressure was 104/66 mmHg, her heart rate was 107 beats/min, and her body temperature was 37.7 °C. Urgent contrast-enhanced abdominal computed tomography (CT) revealed remarkable dilatation of the CBD It demonstrated fluid collection around the CBD, mainly in the retroperitoneal space, and suspicion of a perforated cyst wall (Fig. 1a). Pathologic examination of a specimen revealed no malignancy, and the patient has remained well during the 3-year follow-up
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