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Updated: Feb 27, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Cystic biliary atresia mimicking choledochal cyst: A diagnostic challenge in an infant
Mario Riquelme1, Jorge Alberto Rodriguez-Gomez1, Alejandro Cendejas-Higuera2
1Division of Surgery, Christus Muguerza Hospital, Monterrey, Nuevo Leon, Mexico.
Insights
Cystic biliary atresia (CBA) mimics choledochal cysts, delaying diagnosis in infants. This case highlights intraoperative findings crucial for diagnosing CBA and guiding surgical repair, emphasizing prompt intervention for better outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Cystic biliary atresia (CBA) is a rare biliary atresia (BA) subtype with cystic dilation of the extrahepatic bile duct.
- CBA can be misdiagnosed as choledochal cysts, delaying essential treatment.
- Early diagnosis and management are critical for infants with biliary tract anomalies.
Purpose of the Study:
- To report a case of cystic biliary atresia (CBA) misdiagnosed as a choledochal cyst.
- To emphasize the diagnostic challenges and importance of intraoperative findings in CBA.
- To highlight the surgical management of CBA.
Main Methods:
- Case report of a 2-month-old infant with cholestatic jaundice and a cystic extrahepatic lesion.
- Diagnostic imaging included magnetic resonance cholangiopancreatography (MRCP).
- Intraoperative cholangiography and biliary exploration were performed, followed by laparoscopic and then open surgical repair.
Main Results:
- Initial imaging suggested a choledochal cyst, but intraoperative findings revealed distal ductal obliteration consistent with CBA.
- A laparoscopic hepaticoduodenostomy was converted to an open Roux-en-Y hepaticojejunostomy due to complications.
- Histopathology confirmed the diagnosis of biliary atresia.
Conclusions:
- A high index of suspicion for CBA is necessary in neonates presenting with cystic biliary lesions.
- Intraoperative cholangiography and exploration are vital for accurate diagnosis and surgical planning in suspected CBA.
- Roux-en-Y hepaticojejunostomy is an effective surgical approach for managing CBA.
Abstract:
Cystic biliary atresia (CBA) is a rare subtype of biliary atresia (BA), characterised by cystic dilation of the extrahepatic biliary tract. It can radiologically mimic choledochal cysts, often delaying accurate diagnosis and timely management. We report the case of a 2-month-old male infant who presented with cholestatic jaundice and an extrahepatic cystic lesion suggestive of a choledochal cyst. Initial imaging, including magnetic resonance cholangiopancreatography, revealed a cystic structure in the common bile duct. Intraoperative cholangiography demonstrated a dilated extrahepatic biliary tree without contrast passage to the duodenum; intraoperative biliary exploration confirmed distal ductal obliteration, consistent with CBA with intact proximal ducts. A laparoscopic hepaticoduodenostomy was initially performed; however, due to persistent bile leak and intra-abdominal collection, conversion to open Roux-en-Y hepaticojejunostomy was required. Histopathology confirmed the diagnosis of BA. This case underscores the importance of maintaining a high index of suspicion for CBA in neonates with cystic biliary lesions and highlights the role of intraoperative findings in guiding definitive surgical management.
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