The management of a challenging and sometimes unexpected diagnosis such as choledochal cysts requires the cooperation between a surgeon, a gastroenterologist and a radiologist.
We discuss the case of a 72-year-old male with a medical history of cholelitiasis, third degree hypertension, glaucoma and type 2 diabetes treated (managed) with oral antidiabetic medication, presented with painless jaundice, nausea and vomiting, accompanied by loss of appetite and weight (10 kg).
Laboratory findings showed a slight increase in transaminases level (TGP=81 UI L, TGO=62 UI L) and elevated levels of bilirubin (TBIL=2,34 mg dl, DBIL=2 mg dl). A CT scan indicated a distended gallbladder with thin walls and infundibular gallstones. There was also a dilation of the common bile duct of 2,8 cm in the hilum and 1,6 cm in the segment situated posterior to the pancreas with progressive decrease in caliber towards the distal portion, suggesting a choledochal cyst The patient underwent an ERCP, during which a large biliary sphincterectomy was performed.
Taking into account the special conjuncture and the statistics reported in literature, a simple cholecystectomy without the removal of the cyst was chosen. Given the fact that the cyst was not removed, the patient should be further monitored, as there is a chance of developing a malignancy.Full text sources