Intraoperative diagnosis of choledochal cyst in preparation for laparoscopic cholecystectomy

The initial description of abnormalities of the biliary tree was reported by Vater in 1723. However, it was not until 1959 that Alonzo-Lej and colleagues reported on the full description and classification of choledochal cysts. This report describes a Hispanic female who presented with classic findings consistent with biliary colic. A preoperative ultrasound revealed multiple gallstones and mild dilatation of the common bile duct. At the time of laparoscopy, she was found to have a dilated common bile duct, cystic duct, and gallbladder. Further dissection was discontinued, a cholecystectomy made, and a percutaneous transabdominal cholangiogram through the gallbladder performed, which revealed a type I choledochal cyst (cystic dilatation of the extrahepatic bile ducts). The patient then underwent resection of the extrahepatic biliary tree with a Roux-en-Y hepaticojejunostomy. Her subsequent postoperative course was uneventful. This case illustrates the role of cholangiography using the gallbladder as a conduit in the diagnosis of complex biliary tree anomalies during laparoscopy when the biliary tree cannot be safely accessed.