An 8-year-old girl with recurrent right upper quadrant pain is found to have a fusiform dilatation confined to the extrahepatic bile duct on MRCP. What is the standard operative management?

• A Cholecystostomy tube drainage followed by surveillance
• B Cystoduodenostomy internal drainage
• C Complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓
• D Cholecystectomy alone with annual ultrasound follow-up

Explanation

C fusiform extrahepatic dilatation is a Todani type I choledochal cyst, the commonest type. The accepted operation is complete excision of the cyst with a Roux-en-Y hepaticojejunostomy, because retained cyst mucosa carries a lifelong risk of cholangiocarcinoma, cholangitis and stone formation. Simple drainage procedures such as cystoduodenostomy leave the premalignant mucosa behind and have been abandoned for that reason.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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