A 4-year-old girl with intermittent jaundice and a right upper quadrant cystic mass has MRCP showing fusiform dilatation of the entire extrahepatic bile duct with a normal intrahepatic radicle pattern. This corresponds to which Todani classification type, and what is the definitive treatment?

• A Type II, internal drainage into the duodenum
• B Type IVa, hepatic lobectomy
• C Type V, liver transplantation
• D Type I, complete excision with Roux-en-Y hepaticojejunostomy ✓

Explanation

Fusiform dilatation confined to the extrahepatic duct with normal intrahepatic ducts is Todani type I, the most common choledochal cyst, accounting for roughly half of cases. Definitive treatment is complete cyst excision with biliary-enteric reconstruction by Roux-en-Y hepaticojejunostomy because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma. Internal drainage procedures are abandoned precisely for this reason.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.