An ultrasound in a 5-month-old boy shows a fusiform cystic dilatation of the extrahepatic bile duct with sludge inside. He has intermittent jaundice and a palpable right hypochondrial mass. According to the Todani classification, what is the most common type, and what is the definitive treatment?
- A Type I, complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓
- B Type II, internal drainage via cystoduodenostomy
- C Type IVa, cholecystectomy alone
- D Type V, liver transplantation in all cases
Correct answer: A. Type I, complete excision of the cyst with Roux-en-Y hepaticojejunostomy
Explanation
Todani type I, fusiform dilatation of the extrahepatic bile duct, accounts for the majority of choledochal cysts and produces the classic triad of pain, jaundice, and a right upper quadrant mass. Definitive treatment is complete cyst excision with Roux-en-Y hepaticojejunostomy. Internal drainage procedures such as cystoduodenostomy have been abandoned because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma and recurrent cholangitis.
Reference: Sabiston Textbook of Surgery, 21st ed.
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