An 8-year-old girl presents with intermittent right upper quadrant pain, jaundice, and a palpable mass. MRCP shows fusiform dilatation of the extrahepatic common bile duct with normal intrahepatic ducts. What is the definitive management?

• A Internal drainage by cystoduodenostomy
• B Complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓
• C Endoscopic sphincterotomy and stenting
• D Liver transplantation

Explanation

This is a Todani type I choledochal cyst, the most common variant. Complete cyst excision with Roux-en-Y hepaticojejunostomy removes the mucosa at risk and is the standard definitive operation because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma. Internal drainage procedures such as cystoduodenostomy are abandoned precisely because they leave the premalignant cyst lining behind. Transplantation is reserved for unreconstructable disease.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.