Choledochal Cyst

Dilated

Step 1: View clinicals

A 17 year old girl presents with sharp pain in the right upper abdomen for 1 day, without radiation. Close questioning reveals a 3 year history of mild, intermittent pain in the same region. There was no history of constitutional symptoms or weight loss, while her medical and surgical histories are unremarkable. Her ECG, full blood count, ESR, C-Reactive Protein, urinalysis, and renal functions and electrolytes are all within normal parameters.


Step 2: Order all relevant investigations

Liver Profile

ALT: 151U/L (10-50) AST: 182 U/L (10-50) ALP: 180 U/L (40-125) GGT: 302 U/L (5-55) S. Bilirubin, Albumin, INR: normal

Ultrasound Abdomen

There is focal enlargement of the pancreatic head, along with a peripancreatic fluid collection. The common bile duct is dilated. A 5×4.5 cm cystic structure is seen in proximity to the distal common bile duct and head of the pancreas.

MRCP

MRCP reveals a fusiform dilatation of the common bile duct 5.2×7×4.5 cm in size, located slightly inferior to the origin of the cystic duct.

Serum Amylase + Lipase

Amylase: 512 U/L (<100) Lipase: 270 U/L (10-140)


Step 3: Select appropriate management

Analgesics
High Protein Diet
Total Excision of Cyst
Roux-en-Y Hepaticojejunostomy


Score: ★★☆