Management of an epidermoid cyst of the intrahepatic ducts

Area of Science:

• Hepatobiliary surgery
• Pediatric surgery
• Gastroenterology

Background:

• Epidermoid cysts are rare, typically occurring in the skin or central nervous system.
• Congenital biliary tract abnormalities can present with diverse cystic lesions.
• The occurrence of epidermoid cysts within the biliary tree has not been previously documented.

Observation:

• A neonate presented with a prenatally detected intrahepatic cyst.
• Radioisotope imaging confirmed communication between the cyst and the biliary tree.
• Ultrasound at six months revealed echogenic material within the cyst, suggesting blood or biliary debris.

Findings:

• The cyst was surgically located at the confluence of the hepatic ducts, involving the common hepatic duct.
• Complete cyst resection was performed, preserving the orifices of the left and right hepatic ducts and the common bile duct.
• A Roux-en-Y cyst jejunostomy was established for biliary drainage and future monitoring.

Implications:

• This case establishes the existence of epidermoid cysts in the biliary tree.
• The surgical approach highlights a viable method for managing such rare congenital anomalies.
• The created cyst jejunostomy allows for surveillance of the remnant for potential malignant transformation.