A 4-year-old girl presents with intermittent jaundice, clay-coloured stools, and a palpable cystic mass in the right upper quadrant. MRCP confirms fusiform dilation of the entire extrahepatic biliary tree with normal intrahepatic ducts. After adequate workup, the definitive treatment of choice is:

• A Complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓
• B Cystoduodenostomy
• C Internal drainage with cystojejunostomy and long-term follow-up
• D Hepatic lobectomy of the involved segments

Explanation

This is a Todani type I choledochal cyst, the commonest type. Definitive treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy, because retained cyst mucosa carries a lifetime risk of cholangiocarcinoma, recurrent cholangitis, and anastomotic stricture. Simple internal drainage procedures such as cystoduodenostomy or cystojejunostomy leave the premalignant cyst lining in situ and have been abandoned as primary therapy. Lobectomy applies only to localised intrahepatic disease such as Caroli disease confined to one lobe.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.