title: Intraoperative diagnosis of choledochal cyst in preparation for laparoscopic cholecystectomy.
abstract: The initial description of abnormalities of the biliary tree was reported by Vater in 1723. However, it was not until 1959 that Alonzo-Lej and colleagues reported on the full description and classification of choledochal cysts. This report describes a Hispanic female who presented with classic findings consistent with biliary colic. A preoperative ultrasound revealed multiple gallstones and mild dilatation of the common bile duct. At the time of laparoscopy, she was found to have a dilated common bile duct, cystic duct, and gallbladder. Further dissection was discontinued, a cholecystectomy made, and a percutaneous transabdominal cholangiogram through the gallbladder performed, which revealed a type I choledochal cyst (cystic dilatation of the extrahepatic bile ducts). The patient then underwent resection of the extrahepatic biliary tree with a Roux-en-Y hepaticojejunostomy. Her subsequent postoperative course was uneventful. This case illustrates the role of cholangiography using the gallbladder as a conduit in the diagnosis of complex biliary tree anomalies during laparoscopy when the biliary tree cannot be safely accessed.
authors.affiliation: Department of Surgery, Medical College of Georgia, Augusta.
authors.forename: D H
authors.initials: DH
authors.lastname: Gibbs
authors.forename: D
authors.initials: D
authors.lastname: Crist
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D015529:Choledochal Cyst / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007582:Jejunostomy / Q000379:methods