Choledochal Cysts in Adults: A Case Report and Literature Review

Choledochal cysts are a rare malformation of the biliary tract with an unknown etiology, predominantly affecting Asians and females. Although they are more often diagnosed during childhood, symptoms typically present in young adulthood due to complications. There are no pathognomonic clinical manifestations; the clinical presentation is associated with gallstones, choledocholithiasis, pancreatitis, cholangitis, and an increased risk of malignancy. We report a rare case of a choledochal cyst in adulthood, with delayed diagnosis and management due to the COVID-19 pandemic. A 21-year-old woman, at 34.2 weeks of pregnancy, was diagnosed with cholangitis in 2022. She initially received minimally invasive treatment at another hospital but lost follow-up after discharge due to the COVID-19 pandemic. A year later, her family doctor referred her to our clinic, following protocol for gallstone disease. A diagnostic protocol was initiated, involving multiple imaging studies such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and abdominal computed tomography (CT). These studies allowed us to identify and classify the cyst, enabling proper surgical planning. Open cyst excision with Roux-en-Y hepaticojejunostomy was performed. Biliary cysts represent a rare pathology with potentially serious complications. They are not usually suspected at first in young adults, and the clinical presentation reflects both the cyst and its associated complications. A combination of clinical data, imaging studies, and endoscopy is essential for precise diagnosis, proper classification, and appropriate surgical planning. Total excision with biliodigestive reconstruction through Roux-en-Y bilioenteric anastomosis remains the preferred treatment. Long-term follow-up is necessary due to the potential for complications.