CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2023; 06(02): 154-157
DOI: 10.1055/s-0042-1759682
Case-in-Discussion (Missed Diagnosis)

Spontaneous Rupture of Choledochal Cyst: A Rare Presentation

1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
K.T. Aleena
1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
Arakkal Riyaz
2   Department of Paediatric Gastroenterology, KMCT Medical College, Mukkam, Kozhikode, Kerala, India
E. Devarajan
1   Department of Radiodiagnosis, Govt. Medical College, Kozhikode, Kerala, India
P. Ranjit
3   Department of Pediatric Surgery, Govt. Medical College, Kozhikode, Kerala, India
E.R. Rani Jyothi
4   Department of Pathology, Govt. Medical college, Kozhikode, Kerala, India
› Institutsangaben


Choledochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.


Artikel online veröffentlicht:
09. Januar 2023

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  • References

  • 1 Hewitt PM, Krige JE, Bornman PC, Terblanche J. Choledochal cysts in adults. Br J Surg 1995; 82 (03) 382-385
  • 2 Belli G, Rotondano G, D'Agostino A, Iannelli A, Marano I, Santangelo ML. Cystic dilation of extrahepatic bile ducts in adulthood: diagnosis, surgical treatment and long-term results. HPB Surg 1998; 10 (06) 379-384 , discussion 384–385
  • 3 Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts. Am J Surg 1993; 165 (02) 238-242
  • 4 Lipsett PA, Pitt HA. Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg 2003; 10 (05) 352-359
  • 5 Yamaguchi M. Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am J Surg 1980; 140 (05) 653-657
  • 6 Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 2003; 10 (05) 340-344
  • 7 Moss RL, Musemeche CA. Successful management of ruptured choledochal cyst by primary cyst excision and biliary reconstruction. J Pediatr Surg 1997; 32 (10) 1490-1491
  • 8 Shimura H, Tanaka M, Shimizu S, Mizumoto K. Laparoscopic treatment of congenital choledochal cyst. Surg Endosc 1998; 12 (10) 1268-1271
  • 9 Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg 2004; 91 (12) 1538-1548
  • 10 Lee KF, Lai ECH, Lai PBS. Adult choledochal cyst. Asian J Surg 2005; 28 (01) 29-33
  • 11 Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Spontaneous rupture of choledochal cyst: an unusual cause of acute abdomen in children. J Pediatr Surg 1997; 32 (05) 736-738
  • 12 Chaudhary A, Dhar P, Sachdev A. Reoperative surgery for choledochal cysts. Br J Surg 1997; 84 (06) 781-784
  • 13 Kaneko K, Ando H, Watanabe Y. et al. Secondary excision of choledochal cysts after previous cyst-enterostomies. Hepatogastroenterology 1999; 46 (29) 2772-2775
  • 14 Samavedy R, Sherman S, Lehman GA. Endoscopic therapy in anomalous pancreatobiliary duct junction. Gastrointest Endosc 1999; 50 (05) 623-627
  • 15 Maheshwari M, Parekh BR, Lahoti BK. Biliary peritonitis: a rare presentation of perforated choledochal cyst. Indian Pediatr 2002; 39 (06) 588-592 Accessed April 9, 2022
  • 16 Tanaka M, Shimizu S, Mizumoto K. et al. Laparoscopically assisted resection of choledochal cyst and Roux-en-Y reconstruction. Surg Endosc 2001; 15 (06) 545-552
  • 17 Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM. Variation in management based on type of choledochal cyst. Am J Surg 1991; 161 (05) 612-615
  • 18 Elton E, Hanson BL, Biber BP, Howell DA. Dilated common channel syndrome: endoscopic diagnosis, treatment, and relationship to choledochocele formation. Gastrointest Endosc 1998; 47 (06) 471-478
  • 19 Adamek HE, Schilling D, Weitz M, Riemann JF. Choledochocele imaged with magnetic resonance cholangiography. Am J Gastroenterol 2000; 95 (04) 1082-1083
  • 20 Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Nakagohri T, Ochiai T. Risk of bile duct carcinogenesis after excision of extrahepatic bile ducts in pancreaticobiliary maljunction. Surgery 1999; 126 (05) 939-944
  • 21 Thambi Dorai CR, Visvanathan R, McAll GL. Type IVa choledochal cysts: surgical management and literature review. Aust N Z J Surg 1991; 61 (07) 505-510