MRCP of a 12-year-old girl with recurrent cholangitis shows fusiform dilatation of the extrahepatic bile duct together with multiple cystic dilatations of the intrahepatic ducts on both sides. According to the Todani classification, this is a:

• A Type I choledochal cyst
• B Type II choledochal cyst
• C Type IVA choledochal cyst ✓
• D Type V choledochal cyst

Explanation

Todani type IVA denotes cystic dilatation of both the intrahepatic and extrahepatic bile ducts, whereas type I involves only the extrahepatic duct, type II is a true diverticulum of the supraduodenal duct, and type V is Caroli disease confined to the intrahepatic ducts. Type IVB refers to multiple extrahepatic cysts alone. Complete excision with Roux-en-Y hepaticojejunostomy is preferred because of the high risk of cholangiocarcinoma.

Reference: Sabiston Textbook of Surgery, 21st ed.

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