Synchronous Todani types I and III choledochal cysts in a 10-month-old-infant: type IVb.
A 10-month-old, previously healthy boy presented with one week of mild jaundice, light-colored stools and irritability. Abdominal sonography showed a large type I choledochal cyst and a separate, distinct cystic mass at the head of the pancreas. Magnetic resonance cholangiopancreatography was performed to evaluate the relationship of the two lesions. A type I choledochal cyst was confirmed, and a coexisting type III choledochocele was identified as the second cystic structure in conjunction with pancreaticobiliary malunion. The infant had complete resection of the type I choledochal cyst with Roux-en-Y hepaticojejunostomy, and anterior duodenotomy with marsupialization of the choledochocele. After five years of follow-up, the child is thriving and has had no recurrence of his symptoms. An exhaustive review of the literature identifies only one previous case of synchronous types I and III choledochal cysts, and this association is not clearly defined among the traditional classifications of type IV multiple choledochal cysts. Because operative management of a type III cyst requires the addition of a transduodenal approach, we encourage accurate reporting of mixed type choledochal cysts for the benefit of surgical planning, epidemiologic tracking and outcomes.
Lao
Oliver B
OB
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA. olao@u.washington.edu
Stein
Sharon
S
Ely
Kim A
KA
Lovvorn
Harold N
HN
D000713:Anastomosis, Roux-en-Y; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance; D015529:Choledochal Cyst / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods*; D008099:Liver / Q000601:surgery*; D008297:Male