Choledochal cyst mimicker-When small bowel length matters

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Reconstruction

Background:

• Choledochal cysts necessitate bile duct excision and reconstruction due to malignancy risk.
• Hepatico-jejunostomy is standard but challenging with jejunal limitations.
• Short bowel syndrome presents unique challenges in biliary reconstruction.

Observation:

• A 32-year-old female with short bowel syndrome presented with cholangitis and suspected Type 1 choledochal cyst with choledocholithiasis.
• Imaging revealed common duct stones and fusiform dilatation of the common bile duct.
• Laparoscopic excision and hepatico-duodenostomy were planned.

Findings:

• Successful laparoscopic cholecystectomy, common bile duct (CBD) clearance, and excision were performed.
• Reconstruction was achieved using hepatico-duodenostomy.
• Histology confirmed a dilated bile duct, not a choledochal cyst, and the patient remained asymptomatic.

Implications:

• Laparoscopic hepatico-duodenostomy is a viable alternative for biliary reconstruction in short bowel syndrome.
• Accurate diagnosis of bile duct dilation versus choledochal cyst is crucial.
• This approach offers a safe option when standard conduits are inadequate.