MRCP of a 25-year-old woman with recurrent cholangitis shows cystic dilatation of both the extrahepatic bile duct and the intrahepatic bile ducts. According to the Todani modification of the Alonso-Lej classification, this anomaly is classified as:

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

Explanation

Todani type IVA denotes cystic dilatation involving both the extrahepatic and intrahepatic bile ducts. Type IVB involves multiple extrahepatic segments only, type III is a choledochocele confined to the intraduodenal portion of the common bile duct, and type V is Caroli disease with purely intrahepatic dilatation. Type IVA carries a significant risk of cholangiocarcinoma, so complete excision of the extrahepatic component with hepaticojejunostomy is preferred over simple drainage.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.