A 4-year-old girl presents with intermittent right upper quadrant pain, a palpable cystic mass, and one episode of jaundice. Ultrasound shows a fusiform cystic dilatation of the common bile duct. According to the Todani classification, which type is this, and what is the definitive treatment?

• A Type II, internal drainage by cystoduodenostomy
• B Type IVa, external drainage with a T tube
• C Type I, complete excision with Roux-en-Y hepaticojejunostomy ✓
• D Type V, cholecystectomy alone

Explanation

Fusiform dilatation of the extrahepatic common bile duct is Todani type I, the commonest choledochal cyst, classically presenting with the triad of pain, mass, and jaundice. Definitive treatment is complete excision of the cyst with Roux-en-Y hepaticojejunostomy. Internal drainage procedures such as cystoduodenostomy are abandoned because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma. Type V corresponds to Caroli disease with intrahepatic dilatation, and simple cholecystectomy does not address the diseased duct.

Reference: Sabiston Textbook of Surgery, 21st ed.

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