[Problems in diagnosis and surgical therapy of choledochus cysts. A case report]

We report a case of choledochal cyst accompanied by an adenoid gallbladder carcinoma, in an adult patient. Diagnosis was complicated by coexisting primary hyperparathyroidism. In view of the pathological laboratory tests, which suggested acute pancreatitis, the visualized cystic abdominal mass was regarded as a pancreatic pseudocyst. Neither ultrasound nor CT could clearly define the cyst's origin. Laparotomy, performed later because of deteriorating clinical condition, showed an extended carcinoma which was already invading the liver. Only palliative resection and choledochocystojejunostomy was technically feasible. To prevent the development of malignancies in dilated bile ducts, early treatment by cyst resection and reconstruction of the extrahepatic biliary system is recommended, especially in younger patients.