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A rare but typical complication after surgery for choledochal cyst: case of residual cyst
Menglong Lan
Guangzhou Women and Children's Medical Center,Guangzhou Medical University
Introduction:
Choledochal cysts may involve both extrahepatic and intrahepatic biliary duct dilation. Complete surgical excision is the goal, but residual cysts can occur, leading to significant morbidity. Residual cysts represent incomplete resection of the cyst, which can be challenging due to the intricate anatomy of the biliary tree, especially with multiple dialation of common bile duct.
Case Presentation:
A 9-year-old male, who underwent surgical resection of choledochal cyst at age 5, presented with a 4-days history of intermittent right upper quadrant abdominal pain, episodes of vomit, and diarrhea. Initial laboratory investigations revealed elevated liver enzymes (AST, ALT, GGT) and bilirubin.
A magnetic resonance cholangiopancreatography(MRCP) demonstrated a residual extrahepatic cystic dilatation in the pancreatic portion of the common bile duct. The residual cyst contained sludge and small stones.
The patient reported experiencing similar episodes of pain over the past two years, which were managed conservatively with antibiotics and analgesics. However, the frequency and severity of these episodes had increased recently.
Surgical planning was complex due to the previous surgery and the location of the residual cyst in the pancreas. After careful evaluation, a decision was made for surgical re-intervention . A robotic-assisted surgery was performed, removing the residual cyst and any stones. The patient recovered well post-operatively, with resolution of symptoms and normalization of lab tests. Follow up ultrasound post-operatively showed no evidence of residual cysts or intrahepatic duct dilatation.
Conclusion:
Residual cysts are a significant complication following choledochal cyst surgery, requiring careful post-operative surveillance.Accurate identification and management of residual cysts are essential to prevent recurrent biliary complications.Surgical re-intervention may be necessary, but it can be technically challenging. Long term follow up is required to monitor for residual cysts, and any complications arising from them.