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La Presse Médicale
Volume 41, n° 7-8
pages 769-771 (juillet 2012)
Doi : 10.1016/j.lpm.2011.09.019
Type IA choledochal cyst in adult
Dilatation kystique du cholédoque type IA de l’adulte
 

Sami Daldoul , Amir Moussi, Abdeljelil Zaouche
Surgical Unit A, Charles-Nicole’s Hospital, 1006 Tunis, Tunisia 
University of Tunis El-Manar, Tunis Faculty of Medicine, Tunis, Tunisia 

Sami Daldoul, Department A of general surgery, Charles-Nicole’s Hospital, boulevard 9-avril-1938, 1006 Tunis, Tunisia.

Choledochal cysts are rare congenital abnormalities. Its discovery in adulthood is even rarer. The diagnosis and the classification are carried by MRI. Once the diagnosis was made, the total resection of the choledochal cyst is needed to prevent neoplastic transformation.

We report a case of a 27-year-old woman who was admitted with epigastric pain. She described several episodes of fever with icterus spontaneously resolved. Physical examination revealed a patient without jaundice. The abdomen was soft with a mild right upper quadrant tenderness. Laboratory studies indicated no data perturbation. Ultrasonography showed a cystic lesion of 4cm in transverse diameter next to gallbladder (Figure 1). Magnetic resonance cholangiopancreatography confirmed the diagnosis of choledochal cyst type IA of the Todani classification (Figure 1). At laparotomy, the cystic tumor was 6cm in diameter (Figure 2). It was resected in totality (Figure 3) and biliary reconstruction was performed with a long defunctionalized Roux limb anastomosed to the upper biliary convergence. Choledochal cysts are rare congenital abnormalities that occur in 1 of 50,000 to 1 in 200,000 live births in Western countries [1]. MR cholangiopancreatography has been shown to be 100% accurate in the evaluation of this lesion [2].



Figure 1


Figure 1. 

A. Ultrasonography: Marked dilatation of the extrahepatic biliary tree in its entirety. B. Magnetic resonance cholangiopancreatography: Cystic dilatation of the common bile duct with no anomaly of the intra hepatic biliary tree

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Figure 2


Figure 2. 

Intraoperative findings: Type I choledochal cyst (1: Choledochal cyst; 2: Gallbladder; 3: Duodenum)

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Figure 3


Figure 3. 

A. Total resection of choledochal cyst. B. Specimen. (1: Choledochal cyst; 2: Cystic duct; 3: Gallbladder; 4: Terminal part of choledochal cyst; 5: Hepatic artery; 6: Proximal part of choledochal cyst)

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Disclosure of interest

the authors declare that they have no conflicts of interest concerning this article.

References

Lenriot J.P., Gigot J.F., Segol P., Fagniez P.L., Fingerhut A., Adloff M.The French Associations for Surgical Research Bile duct cysts in adults. A multi-institutional retrospective study Ann Surg 1998 ;  228 (2) : 159-166 [cross-ref]
Chavhan G.B., Babyn P.S., Manson D., Vidarsson L. Pediatric MR. Cholangiopancreatography: principles, technique and clinical applications Radiographics 2008 ;  28 : 1951-1962 [cross-ref]



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