Giant Todani Type IA Choledochal Cyst in an Elderly Patient Successfully Managed With Roux-en-Y Hepaticojejunostomy:...

Choledochal cysts are uncommon congenital anomalies of the biliary tract typically diagnosed during childhood. Presentation in elderly patients is rare and may mimic malignant biliary pathology. We report the case of a 78-year-old female with progressive abdominal discomfort and marked intra- and extrahepatic biliary dilatation. Imaging studies demonstrated a common bile duct measuring 30.9 mm with distal biliary stenosis. Endoscopic retrograde cholangiopancreatography failed to achieve biliary cannulation or stent placement, prompting definitive surgical management. Exploratory laparotomy identified a giant Todani type IA choledochal cyst with approximately 5 cm dilatation. Complete cyst excision and Roux-en-Y hepaticojejunostomy were successfully performed. Histopathological examination confirmed a choledochal cyst without evidence of malignancy. The postoperative course was favorable, with progressive oral intake tolerance and no evidence of biliary leakage or abdominal sepsis. This case highlights the diagnostic and therapeutic challenges associated with choledochal cysts in elderly patients and emphasizes the role of surgical reconstruction when endoscopic management fails.