A New Variant of Choledochal Cyst-Type 6B

A choledochal cyst involving the cystic duct (type 6) is a rare disease. Dilatation of the common bile duct along with the involvement of cystic duct is extremely rare and only a few cases have been reported until now. A 38-year-old woman was evaluated for complaints of pain in the upper abdomen. On initial imaging with ultrasonography (USG) and magnetic resonance cholangiopancreatography (MRCP), she was diagnosed to have a type 1a choledochal cyst. Intraoperatively we found that it was not a simple cystic dilatation of the common bile duct (CBD) alone but the cystic duct was also dilated. Simple cholecystectomy with excision of the cyst and reconstruction with a Roux en Y hepaticojejunostomy was performed. The patient is doing well after six months of follow up. This type of choledochal cyst (CDC) with combined dilatation of cystic duct and CBD has not been defined in the Todani classification. Two studies published until now have given their own extension of the Todani classification as either type 1D or 6B. Our another case where a 23-year-old female with similar complaints was diagnosed with an isolated cystic duct dilatation (type 6A); here, we did a simple laparoscopic cholecystectomy. Thus, we need to know that these distinct type of choledochal cyst exists and has to be added to the classification. It is also important to classify type 6 into two types A and B as their management differs.