A 9-year-old girl presents with intermittent right upper quadrant pain and a palpable mass. Ultrasound and MRCP show fusiform cystic dilatation of the entire extrahepatic bile duct along with multiple segmental dilatations of the intrahepatic ducts. According to the Todani modification of the Alonso-Lej classification, this lesion is:
- A Type IVA ✓
- B Type II
- C Type IA
- D Type IVB
Correct answer: A. Type IVA
Explanation
Todani type IVA denotes cystic dilatation of both the extrahepatic bile duct and multiple intrahepatic ducts, exactly the combination described here. The distinction that kills the tempting distractor is type IVB, which means multiple dilatations confined to the extrahepatic duct alone. Type IA is a single localized extrahepatic cyst, and type II is a true diverticulum of the supraduodenal duct. Standard management regardless of type is complete excision with Roux-en-Y hepaticojejunostomy because of malignancy risk.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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