Related Experiment Video
Updated: May 15, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Spontaneously ruptured choledochal cyst: Rare diagnosis on hepatic scintigraphy
Suneel Chauhan1, Ag Pandit, Mj Jacob
1Department of Nuclear Medicine, Army Hospital Research and Referral, Delhi, India.
Insights
A ruptured choledochal cyst caused biliary peritonitis in an infant. Hepatobiliary scintigraphy (HIDA scan) enabled early diagnosis and successful surgical management, highlighting its importance in rare pediatric surgical emergencies.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Hepatobiliary Medicine
Background:
- Choledochal cysts are congenital dilations of the bile ducts.
- Extrahepatic biliary atresia (EHBA) can present with similar symptoms.
- Rupture leading to biliary peritonitis is a rare but serious complication.
Observation:
- A 47-day-old infant presented with jaundice, abdominal distension, and other symptoms suggestive of choledochal cyst with EHBA.
- Standard anatomical imaging (USG/CT) failed to diagnose the cyst rupture.
- Hepatobiliary scintigraphy (HIDA scan) provided a functional diagnosis of a ruptured choledochal cyst.
Findings:
- The HIDA scan revealed a ruptured choledochal cyst, a diagnosis not achievable with anatomical imaging alone.
- Bilious aspirate confirmed biliary peritonitis.
- Laparotomy with T-tube insertion led to dramatic clinical improvement.
Implications:
- Hepatobiliary scintigraphy is crucial for diagnosing functional abnormalities like choledochal cyst rupture when anatomical imaging is inconclusive.
- Early diagnosis and prompt surgical intervention are vital for managing biliary peritonitis secondary to choledochal cyst rupture.
- This case underscores the importance of considering rare complications and utilizing advanced diagnostic tools in pediatric surgical cases.
Abstract:
A 47-day-old female infant presented with congenital inguinal hernia, seizure on the 2(nd) day of life, fever, progressive jaundice, acholic stools and distension of abdomen. She was suspected to have choledochal cyst with extrahepatic biliary atresia (EHBA) and referred for an Hepatobiliary Tc-99m iminodiacetic acid (HIDA) scan. On HIDA scan, a functional diagnosis of ruptured choledochal cyst was made which was not possible on anatomical imaging like ultrasound (USG)/computed tomography (CT) scan. This was supported thereafter by bilious aspirate on abdominal paracentesis. Immediate laparotomy with T-tube insertion was done. The child improved dramatically after the procedure. Biliary peritonitis secondary to cyst perforation or rupture is a rare complication reported to occur in 1-2% cases of choledochal cyst. Early diagnosis and management is the key to reduce the morbidity and mortality.
