Acquired choledochal cyst following intraabdominal tumor surgical excision: A case report. (September 2020)

• Record Type: Journal Article
• Authors: Gunadi, ; Ramadhita, ; Fauzi, Aditya Rifqi; Melati, Devy; Siahaan, Elena Sophia Elekta Dilean; Daryanto, Eddy; Rusmawatiningtyas, Desy; Damayanti, Wahyu
• Is Part Of: Annals of medicine and surgery. Volume 57(2020)
• Page Start: 270
• Page End: 273
• Publication Date: 2020-09
• Subjects: Acquired choledochal cyst -- Surgical complication -- Intraabdominal tumor excision -- Roux-en-Y hepaticojejunostomy; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2020.08.001
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Choledochal cyst (CC) is a morphological malformation characterized by dilatations of the biliary tree that might present later with clinical symptoms, including jaundice, abdominal pain or pancreatitis. Presentation of case: Here, we reported a 10-month-old female infant with CC presenting with jaundice and a right upper quadrant mass and who was malnourished following a surgical excision of retroperitoneal teratoma one month ago. Laboratory findings were total bilirubin of 14.17 mg/dL, direct bilirubin of 12.24 mg/dL, gamma glutamyl transferase of 1157 U/L, and alkaline phosphatase 187 U/L. Abdominal computed tomography scan showed a CC that caused dilatation of the proximal common bile duct (CBD), common hepatic duct, and intrahepatic bile duct. We decided to perform an explorative laparotomy and found a CC with diameter of 5 cm. Then, we conducted a Roux-en-Y hepaticojejunostomy. Due to hepaticojejunostomy anastomosis leakage, relaparotomies were done. The patient was uneventfully discharged 17 days after the third surgery. Discussion: Our findings are unique because the patient had a normal biliary tree previously and underwent intraabdominal tumor surgery. Notably, besides being an acquired CC, our case might be due to inadvertent bile duct ligation during the first operation or bile duct obstruction as a complication of the first operation. Conclusions: CC should be considered as a potential complication of intraabdominal tumor excision, especially if its location is near the CBD. Roux-en-Y hepaticojejunostomy is still the best choice for CC management. Highlights: The development of acquired choledcohal cyst (CC) might be due to disruption of the biliary tree especially the common bile duct during the excision of intraabdominal tumor. Abdominal computed tomography scan is useful and highly accurate to diagnose of CC. Roux-en-Y hepaticojejunostomy is still the best choice for CC management.