title: Endoscopic biliary drainage as a bridging procedure to single-stage surgery for perforated choledochal cyst: a case report and review of the literature.
abstract: Choledochal cyst (CC)-a congenital anomaly of the bile duct-is rare. We report a 28-year-old woman complaining of epigastralgia who was transferred to our hospital. Physical examination revealed severe tenderness to abdominal palpation without symptoms of diffuse peritonitis. Urgent contrast-enhanced abdominal computed tomography indicated the dilated common bile duct (CBD) was perforated, with a presumed diagnosis of perforated CC. Endoscopic external biliary drainage was performed immediately as a bridging procedure to the definitive surgery. Additional evaluations confirmed a type IVa CC, according to Todani's classification, but no signs of malignancy. Twenty-two days after biliary drainage, laparotomy was performed. A large cystic mass was found in the CBD with a perforated scar on the right-side wall. Because inflammation around the pancreas head was too severe to perform cyst excision safely, the patient underwent subtotal stomach-preserving pancreatoduodenectomy. The postoperative course was uneventful, and the patient was discharged on the 29th postoperative day. Pathologic examination of a specimen showed no malignancy, and the patient has remained well during the 3-year follow-up. Our experience with this case suggests that definitive single-stage surgery for perforated CC in an adult can be performed safely owing to external biliary drainage as a bridging procedure, if manifestation of diffuse peritonitis is not evident.
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.|Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Minagawa
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan. dowaki@biscuit.ocn.ne.jp.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Dowaki
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kikunaga
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Sakuragawa
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ichisaka
authors.affiliation: Department of Radiology, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.affiliation: Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.affiliation: Division of Diagnostic Pathology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Mikami
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
keywords: Adult; Choledochal cyst; Endoscopic biliary drainage; Perforation; Single-stage surgery