Abstract
Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP) and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.
Highlights
Choledochal cyst (CC) is a rare congenital but not familial anomaly of either intrahepatic or extrahepatic biliary tract [1,2,3]
The diagnosis of choledochal cyst is usually made in childhood (50% of cases were diagnosed in the first decade of life), and the rest might be seen later in adults with symptoms related to the biliary tract pathology [2, 5]
The diagnosis is delayed in approximately 20% of cases, and these patients might be recognized first as adults with symptoms related to biliary tract pathology
Summary
Choledochal cyst (CC) is a rare congenital but not familial anomaly of either intrahepatic or extrahepatic biliary tract [1,2,3]. Todani and colleagues’ modified classification is the most commonly used [1, 6, 7] This classification describes 5 types of CC. 6 cases of mixed type I and II choledochal cyst have been reported, 4 cases in children and 2 cases in adults. In all these cases, fusiform dilatation of the CBD with a diverticulum arising from the CBD was found [8, 9]. We report an adult patient who had cystic dilation of the CBD (type I CC), along with a diverticulum (type II) arising from its lateral part
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