Choledochal Cysts in Adults: A Case Report and Review of Literature

Choledochal cyst is an uncommon disease that affects especially the pediatric population, although the diagnosis in adulthood has become frequent in the last few years. The treatment depends on the type of the cyst, but total excision of the cyst must be performed when it is possible. We report a 16-year-old female patient who presented with long-term unspecific symptoms alike colic biliary pain. Although abdominal ultrasound revealed no cholelythiasis, it suggested focal dilatation in the choledochal duct, which was confirmed by Endoscopic Retrograde Cholangiopancreatography (ERCP) as choledochal cyst Type IB of Todani. The patient was submitted to a laparoscopic cholecystectomy, excision of the cyst, and Roux-en-Y hepaticojejunostomy reconstruction. There were no postoperative complications. The diagnosis of choledochal cyst in adulthood has some particularities compared to its diagnosis in childhood, such as a different presentation and a greater association with other hepatobiliary diseases. Total excision of the cyst is the general principle for the treatment, which reduces the risk for cancer development. The way of reconstruction is discussed, comparing hepaticoduodenostomy and hepaticojejunostomy, and both the procedures are acceptable. Laparoscopic surgery is feasible and the preferable approach. Excision of the cyst is the main step of the treatment. Laparoscopic approach is feasible, but must be reserved for experienced surgeons in complex biliary procedures and in advanced laparoscopic surgery.