Case Report: Isolated Cystic Dilatation of the Cystic Duct: A Misdiagnosed Case Preoperatively

Abstract

A 33-year-old female with a mild elevation of liver transaminase was sent to the general surgery department for medical services due to upper-right abdominal pain for 2 weeks. A liquid dark area ~4 × 3 × 3 cm in size in the theoretical location of the pancreatic segment of the common bile duct was detected by abdominal CT with no enhancement of the cystic wall found in the enhanced CT scan. The patient was then diagnosed with a choledochal cyst based on the results of the radiological images preoperatively. During the operation, the isolated cystic dilatation was found in the middle part of the cystic duct, and its caudal portion was found behind the head of the pancreas and converged into the common bile duct at an acute angle and low insertion. According to the intraoperative evaluation, the female was then diagnosed with a cystic duct cyst (CDC). The surgery was converted to a laparotomy for the unclear structure and the possibility of anatomic variation of the bile duct. The caudal portion of the cystic duct was found communicated with the common bile duct with a narrow base, and the extrahepatic bile duct was not cystic. The CDC was removed in the surgery. One week later, the patient was discharged from the hospital for the disappearance of abdominal pain and normal liver transaminase and did not report any discomfort in the 1-month-long follow-up. The lessons drawn from this case were as follows: (1) the distinction between the relatively frequent choledochal cyst and the isolated CDC should always be taken in mind; (2) a surgical strategy should be given priority for an intraoperatively confirmed CDC; (3) a common bile duct exploration is recommended for patients with choledocholithiasis or jaundice.

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“…But the diagnosis of this anomaly depends on correct intraoperative exploration for exact confirmation [5].…”

A new variant of Choledochal cyst-type VI: a rare case presentation and review of the literature

“…Clinical symptoms of cystic duct cysts are usually similar to other types of Choledochal cysts. According to anatomical position and size of the cystic lesions, clinical symptoms range from asymptomatic to abdominal pain, abdominal mass, and jaundice [ 4 , 10 ]. However, clinical symptoms lack specificity, so preoperative identification is not highly accurate and often falsely reported as other types of Choledochal cysts in imaging examinations.…”

“…One is that cystic duct wall develops unevenly due to the lack of ganglion cells or the abnormal development of embryonic cells during embryonic development. Second, abnormal dilatation of cystic duct caused by abnormalities at the junction of the pancreaticobiliary duct or reflux of pancreatic juice [ 4 , 8 , 15 ]. The cancer risk in bile duct cysts would be increasing with age [ 16 ].…”

“…Biliary cysts of the cystic duct are very rare [ 2 ]. Bode and Serena had identified this disease as a new type of Choledochal cysts in 1983 and 1991, which named cystic duct dilatation cysts, and classified as Todani type VI [ 4 ]. More and more scholars have also accepted that cystic duct dilatation cysts are included in Type VI Choledochal cysts [ 5–7 ].…”