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Updated: Dec 10, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Acquired choledochal cyst following intraabdominal tumor surgical excision: A case report
Gunadi1, Ramadhita1, Aditya Rifqi Fauzi1
1Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Insights
This case report details an acquired choledochal cyst (CC) in an infant following abdominal tumor surgery. Roux-en-Y hepaticojejunostomy was successfully performed to manage the biliary dilatation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary Tract Disorders
Background:
- Choledochal cysts (CC) are congenital biliary dilatations that can lead to jaundice, pain, and pancreatitis.
- Acquired CC is rare, particularly in infants, and its etiology requires careful consideration.
Observation:
- A 10-month-old infant presented with jaundice and an abdominal mass post-retroperitoneal teratoma excision.
- Imaging revealed a 5 cm choledochal cyst causing proximal biliary dilatation.
- The infant had a history of prior intra-abdominal tumor surgery.
Findings:
- The patient developed an acquired choledochal cyst, potentially linked to the prior abdominal surgery.
- Roux-en-Y hepaticojejunostomy was performed for management.
- Post-operative complications necessitated relaparotomies, but the patient was ultimately discharged.
Implications:
- Choledochal cysts should be considered a potential complication after intra-abdominal tumor excision, especially when the tumor is near the common bile duct.
- Roux-en-Y hepaticojejunostomy remains the preferred surgical approach for choledochal cyst management.
Introduction:
Choledochal cyst (CC) is a morphological malformation characterized by dilatations of the biliary tree that might present later with clinical symptoms, including jaundice, abdominal pain or pancreatitis.
Presentation Of Case:
Here, we reported a 10-month-old female infant with CC presenting with jaundice and a right upper quadrant mass and who was malnourished following a surgical excision of retroperitoneal teratoma one month ago. Laboratory findings were total bilirubin of 14.17 mg/dL, direct bilirubin of 12.24 mg/dL, gamma glutamyl transferase of 1157 U/L, and alkaline phosphatase 187 U/L. Abdominal computed tomography scan showed a CC that caused dilatation of the proximal common bile duct (CBD), common hepatic duct, and intrahepatic bile duct. We decided to perform an explorative laparotomy and found a CC with diameter of 5 cm. Then, we conducted a Roux-en-Y hepaticojejunostomy. Due to hepaticojejunostomy anastomosis leakage, relaparotomies were done. The patient was uneventfully discharged 17 days after the third surgery.
Discussion:
Our findings are unique because the patient had a normal biliary tree previously and underwent intraabdominal tumor surgery. Notably, besides being an acquired CC, our case might be due to inadvertent bile duct ligation during the first operation or bile duct obstruction as a complication of the first operation.
Conclusions:
CC should be considered as a potential complication of intraabdominal tumor excision, especially if its location is near the CBD. Roux-en-Y hepaticojejunostomy is still the best choice for CC management.
