CASE REPORT

A giant choledochal cyst in 8 years old female

Eva JJ Sapulete , I Gusti Ngurah Sanjaya Putra, I Putu Gede Karyana, Ni Nyoman Metriani Nesa, I Made Darmajaya, Kadek Deddy Ariyanta

Eva JJ Sapulete
Departments of Child Health, Udayana University Medical School, Sanglah Hospital Denpasar. Email: [email protected]

I Gusti Ngurah Sanjaya Putra
Departments of Child Health, Udayana University Medical School, Sanglah Hospital Denpasar

I Putu Gede Karyana
Departments of Child Health, Udayana University Medical School, Sanglah Hospital Denpasar

Ni Nyoman Metriani Nesa
Departments of Child Health, Udayana University Medical School, Sanglah Hospital Denpasar

I Made Darmajaya
Departments of Child Surgery, Udayana University Medical School, Sanglah Hospital Denpasar

Kadek Deddy Ariyanta
Departments of Child Surgery, Udayana University Medical School, Sanglah Hospital Denpasar
Online First: August 01, 2019 | Cite this Article
Sapulete, E., Putra, I., Karyana, I., Nesa, N., Darmajaya, I., Ariyanta, K. 2019. A giant choledochal cyst in 8 years old female. Medicina 50(2). DOI:10.15562/medicina.v50i2.110


Choledochal cyst incidence in Asian population is 1 : 1000 live births and more common in female. The classic triad can be found in younger children is icteric, abdominal pain, and palpable mass in the abdomen. Various technique has been performed, but cyst excision and Roux-en-Y hepaticojejunostomy still prefered. Inappropriate management can cause several complications. We describe a rare case of Giant Choledocal Cyst, 8 years old female present abdominal pain and a palpable mass in abdomen from below arcus costae to right inguinal region. Laboratory finding show serum bilirubin, alkaline phosphatase, gamma-glutamyl transferase level are elevated. Computered tomography scan shows type IV choledochal cyst, with size 117.1 x 83.5 mm. First step surgery, external drainage was performed. The definitive surgery was incomplete cyst excision and Roux-en-Y hepaticojejunostomy. The patient was discharged in good condition. The long-term prognostic is dubia ad bonam, biliary tract malignancy may still occur.

Insiden kista koledokus di Asia adalah 1 : 1000 kelahiran hidup dan lebih banyak pada perempuan. Trias klasik pada anak adalah ikterus, nyeri perut, dan teraba massa di abdomen. Beberapa teknik dapat dilakukan namun paling baik adalah eksisi kista dan Roux- en-Y hepatikojejunostomi. Kami melaporkan sebuah kasus jarang giant choledocal cyst pada perempuan 8 tahun dengan keluhan nyeri perut dan teraba massa di bawah arkus kosta sampai inguinal kanan. Laboratorium menunjukkan peningkatan serum bilirubin, alkaline fosfatase, dan gamma-glutamil transferase. Computered tomography scan menunjukkan kista koledokus tipe IV, ukuran 117,1 x 83,5 mm. Pembedahan tahap pertama adalah drainase eksternal. Pembedahan de nitif adalah eksisi kista parsial dan Roux-en-Y hepaticojejunostomi. Pasien pulang dalam kondisi baik. Prognosis jangka panjang dubia ad bonam, dan keganasan saluran bilier dapat terjadi.

 

 

References

Waidner U, Doris HB, Klaus B. Choledochal cyst as a diganostic pitfall:a case report. J of medical case report. 2008;2:1-4.

Singharm J, Eric MY, Charles HS. Choledochal cyst part 1 of 3:classification and pathogenesis. J can chir. 2009;52:434-40.

Congo K, Maria FL, Patricia HO, Hugo M, Susana B, Aurelio R. Outcomes of choledochal cyst with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy. Annals of Hepatology. 2012;11:536-43.

Littooij AS, Fortier. Classification of choledochal cyst with MR cholangiopancreatography in children and infants:special reference to type Ic and type Iva cyst. European Sociaety of Radiology. 2011:10-5.

Plessis AM, Ellie G, Savvas A. Choledochal cyst-an unusual cause of jaundice in adults. SA Journal of Radiology. 2007;11:101-2.

Yurttutan N, Suleyman CK, Naim K, Mustafa D, Ramazan U. A giant choledochal cyst in infancy:a case report. Korean J Pediatr. 2016;59:239-41.

Bhavsar MS, Hasmukh BV, Venugopal HG. Choledochal cysts:a review of literature. Suadi J Gastroenterol. 2012;18:230-6.

Elhalaby E, Hashish A, Elbarbary M, Elwagih M. Roux-En-Y hepaticojejunostomy versus hepaticodudenostomy for biliary reconstruction after excision of choledochal cysts in children. Annals of Pediatric Surg. 2005;1:79-85.

Anand U, Rajeev NP, Bindey K. A giant type IVA choledochal cyst. Annals of Gastroentrology. 2012;25:73-5.

Huang CS, Huang CC, Chen DF. Choledochal cyst: differences between pediatric and adults patient. J Gastrointest Surg. 2010;14:1105-10.

Rozel C, Garel L, Rypens F, Viremouneix L, Lapierre C, Decarie JC, et al. Imaging of biliary disoredrs in children. Pediat Radiol. 2011;41:208-20.

Mishra A, Pant N, Chada R, Choudhury SR. Choledochal cyst in infancy and childhood. Indian J Pediatr. 2007;74:937-42.

Wibowo S, Kanadiharddja W, Sjamsuhidajat R, Syukur A. Saluran empedu dan hati. In: Sjamsuhidajat R, Karnadihardja W, Prasetyono TOH, Rudiman R, editors. Buku Ajar Ilmu Bedah Sjamsuhidajat-De Jong. 3rd ed. Jakarta:EGC, 2011. p.564-6.

Coran AS, Scott A, Thomas MK, Jean ML, Anthomy C, Robert S. Pediatric surgery. In : Kell D, Hanmin L, editors. Choledochal cyst. Philadelphia : Elsevier Inc, 2012. p.1331-9.

Tadokoro H, Takase M. Recent advances in choledochal cysts. Open Journal of Gastroenterology. 2012;2:145-54.

De Vries JS, De Vries S, Aronson DC, Bosman DK, Rauws EA, Bosma A, et al. Choledochal cysts: age of presentation, symptoms, and late complications related to Todani’s classification. J Pediatr Surg. 2002;37:1568-73.

Anand U, Rajeev NP, Bindey K, Chiranjeev K. Diagnosis and management of giant choledochal cysts: compelxities compared to smaller cysts. Indian J gastroenterol. 2013;32:262-7.

Khare MK, Manish D, Tarun N, Manoj KM. Giant choledochal cyst. Tropical Gastroneterology J. 2015;36:120-1.

Bin Shi L, Shou YP, Xing KM, Cheng HP, Ying BL, Xiao PC, et al. Diagnosis and treatment of congenital choledochal cyst: 20 years’ experinece in China. Worls J Gastroenterol. 2001;7:732-4.

Buyukyavuz I, Saniye E, Arbay OC, Ibrahim K, Mehmet E, Senocak, et al. A retrospective study of choledochal cyst: clinical presentation, diagnosis and treatment. The Turkish J of Pediatr. 2003;45:321-5.

Lee HK, Seong JP, Burn HY, A Leum L, Jong HM, Yun WC. Imaging features of adult choledochal cysts:a pictorial review. Korean J Radiol. 2009;10:71-80.

Beuers U, Boberg KM, Chapman RW, Chazouille O, Invernizzi P, Jones DEJ, et al. EASL clinical practice guidelines: management of cholestatic liver diseases. J Hepatol. 2009;51:237-67.

Shneider BL, Magee JC, Bezerra JA, Haber B, Karpen SJ, Raghunathan T, et al. Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia. Pediatrics. 2012;130:607-14.

Gardikis S, Antypas S, Kambouri K, Lainakis N, Panagidis A, Deftereos S, et al. The Roux-en-Y procedure in congenital hepatobiliary disorders. Romanian Journal of Gastroenterology. 2005;14:135-40.

Jesudason SRB, Mukha RP, Vyas FL, Govil A, Muthusami JC. Management of adult choledochal cysts-a 15 year experience. HPB (Oxford). 2006;8:299-305.

Koncoro H, Wibawa IDN. Acute pancreatitis as a complication of choledochal cyst. The Indonesian journal of gastroenterology hepatology and digestive endoscopy. 2012;13:123-7.

Diao M, Long L, Qi L, Mao Y, Wei C. Challenges and strategies for single-incision laparoscopic Roux-en-Y hepaticojejunostomy in managing giant choledochal cysts. Int J Surg. 2014;12:412-7.

Kumar GCM, Rajagopalan BS. Choledochal cyst. Medical Journal Armed Forces India. 2012;68:296-8.

Hay SA. Laparascopic mucosectomy for large choledochal cyst. J of Laparoendoscopic & Advanced Surgc Tech. 2008;18:783-5.

Okoromah CN, Odelola, Etukudo. Complicated massive choledochal cyst: a case report. Nigerian J of Clinical Practice. 2002;5:150-2.

Soares KC, Dean JA, Ihab K, Neda R, Robert A, Shishir M, et al. Choledochal cysts: presentation, clinical differentiation, and management. J American College of Surg. 2014;219:1167-80.

Ono S, Shigehisa F, Shinichi S, Naomi I. Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J of Pediatr Surg. 2010;45:376-8.


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