Choledochal cyst with cholelithiasis: 15-yr follow-up

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Imaging

Background:

• Choledochal cysts are congenital dilations of the bile ducts.
• Surgical intervention in infancy aims to prevent complications such as stones and malignancy.
• Recurrent symptoms necessitate thorough investigation to rule out residual or new pathology.

Observation:

• A 15-year-old male presented with recurrent right upper quadrant pain.
• Previous surgical history included choledochal cyst repair in infancy.
• Diagnostic imaging revealed a persistent choledochal cyst containing gallstones.

Findings:

• Intravenous cholangiography and ultrasound confirmed the presence of a choledochal cyst with calculi.
• Angiography identified vascular anomalies, specifically a distorted gastro-duodenal artery branch.
• Intraoperative findings corroborated the imaging results, confirming the choledochal cyst and stones.

Implications:

• Choledochal cysts can recur or present with complications even after initial surgical management.
• Recurrent abdominal pain in patients with a history of choledochal cysts warrants comprehensive diagnostic evaluation.
• Accurate imaging and surgical confirmation are crucial for managing complex cases of choledochal cysts.