A 25-year-old woman with recurrent cholangitis has MRCP showing fusiform dilatation of the entire extrahepatic bile duct together with cystic dilatation of intrahepatic ducts. According to the Todani classification and standard practice, the correct procedure is:

• A Internal drainage by cystoduodenostomy
• B Liver transplantation
• C Hepatic lobectomy of the involved lobe only
• D Complete excision of the extrahepatic cyst with Roux-en-Y hepaticojejunostomy ✓

Explanation

Dilatation of both intrahepatic and extrahepatic ducts defines Todani type IVa choledochal cyst. Because the cyst epithelium carries a high lifetime risk of cholangiocarcinoma, recurrent cholangitis, and pancreatitis, the accepted operation is complete excision of the extrahepatic cyst with drainage by Roux-en-Y hepaticojejunostomy. Internal drainage procedures such as cystoduodenostomy leave the premalignant cyst lining in situ and have been abandoned. Transplantation is not indicated unless secondary biliary cirrhosis is established.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.