A 12-year-old girl with recurrent right upper quadrant pain and jaundice has MRCP showing fusiform dilatation of the extrahepatic bile duct together with segmental dilatation of the right and left intrahepatic ducts. According to the Todani classification, this is:

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

Explanation

Todani type IVA denotes cystic or fusiform dilatation of the entire extrahepatic bile duct combined with intrahepatic duct dilatation, exactly as described here. Type I involves only the extrahepatic duct, type II is a true diverticulum of the supraduodenal duct, and type III is a choledochocele confined to the intraduodenal segment. Definitive treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy because of the high risk of cholangiocarcinoma.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.