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Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
[Minimally invasive management of Choledochal Cyst in pediatric age]
David Schnettler R1, Janitza Norín M1, Rafael López D1
1Facultad de Medicina, Universidad Católica del Maule, Talca, Chile.
Insights
Choledochal cysts are rare but treatable with timely diagnosis and minimally invasive laparoscopic surgery. These techniques offer excellent long-term outcomes for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Choledochal cysts are rare congenital biliary tract malformations.
- Early diagnosis and appropriate management are crucial for preventing complications and ensuring favorable outcomes.
Observation:
- Three pediatric cases of choledochal cysts are presented, including presentations with abdominal pain and acute pancreatitis.
- Diagnostic imaging modalities like ultrasound, CT scan, and MRCP were utilized for diagnosis.
- All patients were diagnosed with Type I choledochal cysts.
Findings:
- Laparoscopic surgery involving cyst resection and hepaticoduodenostomy was performed in all cases.
- One patient experienced pneumobilia post-surgery, requiring no specific intervention.
- All patients remained asymptomatic during the follow-up period exceeding one year.
Implications:
- Clinical suspicion combined with timely imaging is vital for diagnosing choledochal cysts.
- Minimally invasive laparoscopic surgery leads to optimal medium- and long-term results.
- This approach facilitates successful management of choledochal cysts in pediatric patients.
Introduction:
The choledochal cyst (also bile duct cyst) is a rare condition. It is important to know its clinical presentation, diagnosis, and treatment alternatives, which allow a resolution with low morbidity.
Objective:
to report the clinical diagnosis together with the laparoscopic techniques for the mana gement of the bile duct cyst.
Clinical Cases:
Case 1: 4-year-old preschooler with history of recurrent abdominal pain. Abdominal ultrasound showed a choledochal cyst. Blood amylase levels 111 IU / L. Other tests were normal. Case 2: 5-year-old preschooler with a 5-days history of abdominal pain, vomiting, and diarrhea. He was admitted due to acute pancreatitis (blood lipase 947 IU / L, blood amylase 217 IU / L). Abdominal CT scan reported a lobulated cystic lesion in the hilum of the liver. Case 3: 3-year-old preschooler with recurrent abdominal pain and a 3-day history of epigastric pain and vomiting. Blood amylase and lipase levels were 248 IU / L and 253 IU / L, respectively, diagnosing acute pancreatitis. Abdominal CT scan showed a finding suggestive of a common bile duct cyst. In all 3 cases, the magnetic resonance cholangiopancreatography reported a type I choledochal cyst. All pa tients underwent laparoscopic surgery, performing cyst resection, and hepaticoduodenostomy. One case presented pneumobilia without requiring specific management, the other two did not present incidents and all remain asymptomatic in the follow-up period that was longer than one year after surgery.
Conclusions:
In the choledochal cyst, clinical suspicion and timely diagnosis with imaging studies and minimally invasive surgery are important, which allow optimal results in the medium- and long term.
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