Delayed upper gastrointestinal bleeding after laparoscopic treatment of forme fruste choledochal cyst

Delayed upper gastrointestinal (UGI) bleeding after surgery is a catastrophic event with high mortality unless diagnosed early. In this paper, report a case of massive UGI bleeding 1 month after the laparoscopic treatment of a forme fruste choledochal cyst (FFCC).

A 8-year-old girl presented at our attention because of acute pancreatitis. Ultrasound and magnetic resonance cholangiopancreatography diagnosed an FFCC. Once serum amylase and lipase were normal, a laparoscopic extrahepatic bile duct excision (EHBD) with a Roux-en-Y hepaticojejunostomy was performed without intraoperative complication. One month later, the patient had massive UGI bleeding, and laparotomic treatment of duodenal bleeding was necessary because of hemodynamic instability. Despite intravenous omeprazole and somatostatin, 1 week later, a new massive UGI bleeding occurred during hospitalization and an antral gastric resection with gastrojejunostomy (Billroth II) was performed. The patient was discharged 3 weeks later and she is well at 18-months of follow-up. EHBD excision with a Roux-en-Y hepaticojejunostomy is the treatment of choice for FFCC; laparoscopic approach is feasible and effective in children, too. The severe complication reported seems not related to the minimal invasive approach; in fact, it can occur after pancreatic or biliary surgery.