A Unique and Rare Presentation of Obstructed Choledochal Cyst in an Adult: A Case Report

Ahmad E. Al-Mulla*, Salah Termos, Fawzia Ashkanani, Ehab S. Imam, Abdulla E. Sultan, Ali Altabeekh, Mohammad Y. Saleh and Ahmad Al-Jafar

A Unique and Rare Presentation of Obstructed Choledochal Cyst in an Adult: A Case Report.

The hepatobiliary team elected to proceed with a laparotomy. Extensive adhesiolysis
was performed due to severe adhesions from the patient’s previous surgery. The team worked to identify the
choledochal cyst and the old cholecystojejunostomy, which was
obstructed by gallstones and sludge.

The cyst was carefully dissected from the porta hepatis: the hepatic artery and portal vein. The
surgical team performed en bloc excisions of the choledochal cyst,
gallbladder and segmental jejunal with stent removal. A Roux-En-Y jejuno-jejunostomy and
a Hutson Russel loop at the right upper quadrant were made. Two
drains were placed at the anastomosis and pelvis.

The patient’s post-operative recovery on the ward was uneventful. She continued taking
antibiotics while hospitalised and did not experience any bile leakage from her drains. The drains were
removed, and her liver profile was normal.

The first outpatient visit after 14-days was unremarkable. The patient tolerated a regular
diet with no abdominal pain, fever or changes in bowel habits. The
wound was clean, and the patient’s histopathology result showed
acute cholecystitis and a choledochal cyst.

Choledochal cysts are extremely rare pathologies in adults because
they mainly appear in childhood. They may present with ambiguous signs and
symptoms; diagnosing such a disease is challenging and requires careful investigation.

Treatments for this disease are diverse; however, resection and hepaticojejunostomy remain the
best bilioenteric therapeutic options. Awareness of this congenital abnormality and
familiarity with its potential complications can lead to better outcomes. We recommend
referring those patients to hepatobiliary specialists to follow the appropriate
therapeutic management to avoid future complications and have better prognoses.

Surg Res Open J. 2021; 6(1): 13-16. doi: 10.17140/SROJ-6-127