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A rare biliary tree anomaly coinciding with type I choledochal cyst in a pediatric patient: a case report
Polychase Magaoay, Maria Consuela Imelda Lopez-Apeles, Raymond Joseph De Vera
Rizal Medical Center, Pasig City, Philippines
Introduction
Multiple studies have previously reported anomalies in the biliary tree anatomy. An example is the interposition of the gallbladder, an extremely rare developmental anomaly wherein the right and left hepatic ducts drain directly into the gallbladder, with an absent common hepatic duct and often with an absent common bile duct (CBD). Another rare condition concerning the biliary tree is a choledochal cyst, which is a congenital dilatation of extrahepatic and/or intrahepatic bile ducts.
Case Presentation
In this case report, we present a rare case of coincidental choledochal cyst and interposition of gallbladder in a pediatric patient. A 1 year old female presents with a 2 week history of jaundice, tea-colored urine, acholic stools, and occasional vomiting episodes. Whole abdomen CT and plain MRCP showed fusiform dilation of the common bile duct with mild intrahepatic biliary ductal dilatation, hence, the patient was initially assessed as choledochal cyst type I. The patient then underwent excision of choledochal cyst. Intraoperatively, we noted a fusiform dilated CBD with a contracted gallbladder, and absence of the common hepatic duct. The gallbladder fossa was noted to have an orifice with bile drainage. Intraoperative ultrasound confirmed that the intrahepatic duct is connected to the gallbladder fossa orifice, hence the intrahepatic ducts directly drain into the gallbladder. Subsequent reconstruction by Roux-en-Y portoenterostomy was done.
Conclusion
Biliary tree anomalies are often discovered intraoperatively, hence it is important to be able to recognize them due to the high potential for iatrogenic injury. In pediatric patients, it is also crucial to identify biliary tree anomalies early due to the risks of progressive liver damage, and long-term sequelae such as cirrhosis or malignancy. To our knowledge, this is the first reported case of choledochal cyst coinciding with interposition of the gallbladder.