Case reports of interest Management of a ruptured bile duct cyst

A 25-year-old male patient, with a past medical history of transient jaundice in infancy, was initially admitted to another Medical Center’s Surgical Department. The patient presented with acute abdomen, with severe diffuse abdominal pain radiating to the ipsilateral flank, a palpable right-upper quadrant abdominal mass, and jaundice. Surgical exploration revealed an extended cyst of the common hepatic and common bile duct and concomitant biliary peritonitis. At that time, a T-tube cystostomy of the bile duct cyst was performed for temporary external drainage. Additional treatment for an ensuing surgical-site infection included surgical drainage and antibiotics. Two months after the initial operation, he was admitted to our department for further evaluation and surgical treatment of the underlying disease. Abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP), as well as abdominal computed tomography (CT) scan, showed a congenital choledochal cyst, type IV-A, according to Todani’s classification. Cholescintigraphy scan with intravenous radioactive hydroxyl iminodiacetic acid (HIDA) demonstrated obstruction of the common bile duct from a cystic lesion. T-tube cholangiography revealed the cystic lesion of the bile duct (Fig. 1). Additionally, images gained by three-dimensional (3D) CT of the upper abdomen, reconstructing the whole length of the biliary system, were obtained, and are presented in Fig. 2. The absence of pancreatobiliary malunion (PBM) and the presence of a primary ductal hilar stricture, with concomitant dilatation of the hepatic bifurcation, were the key points required in order to classify this congenital cystic malformation as type IV-A. Abstract A case of a ruptured bile duct cyst in a 25-year-old male patient is presented. The initial management of the clinical presentation of acute abdomen consisted of an exploratory laparotomy and a T-tube cystostomy of a choledochal cyst. Two months later, he was admitted to our surgical department. Preoperative evaluation showed a type IV-A choledochal cyst. The patient underwent excision of the choledochal cyst, cholecystectomy, and the construction of a Roux-en-Y end-to-side hepaticojejunostomy.