Endoscopic biliary drainage as a bridging procedure to single-stage surgery for perforated choledochal cyst: a case report and review of the literature

Abstract

Choledochal cyst (CC)—a congenital anomaly of the bile duct—is rare. We report a 28-year-old woman complaining of epigastralgia who was transferred to our hospital. Physical examination revealed severe tenderness to abdominal palpation without symptoms of diffuse peritonitis. Urgent contrast-enhanced abdominal computed tomography indicated the dilated common bile duct (CBD) was perforated, with a presumed diagnosis of perforated CC. Endoscopic external biliary drainage was performed immediately as a bridging procedure to the definitive surgery. Additional evaluations confirmed a type IVa CC, according to Todani’s classification, but no signs of malignancy. Twenty-two days after biliary drainage, laparotomy was performed. A large cystic mass was found in the CBD with a perforated scar on the right-side wall. Because inflammation around the pancreas head was too severe to perform cyst excision safely, the patient underwent subtotal stomach-preserving pancreatoduodenectomy. The postoperative course was uneventful, and the patient was discharged on the 29th postoperative day. Pathologic examination of a specimen showed no malignancy, and the patient has remained well during the 3-year follow-up. Our experience with this case suggests that definitive single-stage surgery for perforated CC in an adult can be performed safely owing to external biliary drainage as a bridging procedure, if manifestation of diffuse peritonitis is not evident.

Management of Complicated Choledochal Cyst in Children: Ultrasound-Guided Percutaneous External Drainage and Subsequent Definitive Operation

“…Patients with complicated choledochal cyst often had a distal biliary obstruction that led to bile stasis and ultimately developed severe complications, such as acute cholangitis, abnormal liver function, and even perforation of choledochal cysts and coagulopathy [10][11][12]. Conventionally, these patients required two-stage operations, an emergent external biliary drainage and subsequent de nitive operation [11,13,14]. The methods of external drainage mainly included biliary drainage of extrahepatic cyst or intrahepatic bile duct, and gallbladder drainage or cholecystostomy [10,[14][15][16].…”