A 5-year-old girl with recurrent right upper quadrant pain is found to have fusiform dilatation of the extrahepatic bile duct on ultrasound, with anomalous pancreaticobiliary ductal union on MRCP. According to the Todani classification this is a type I choledochal cyst. What is the correct surgical treatment?

• A Internal drainage by cystoduodenostomy
• B Hepatic lobectomy of the involved lobe
• C Cholecystectomy alone with sphincterotomy
• D Complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓

Explanation

Todani type I cysts are fusiform or cystic dilatations of the common bile duct and account for the majority of choledochal cysts. Definitive treatment is complete cyst excision with cholecystectomy and Roux-en-Y hepaticojejunostomy, because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma. Simple internal drainage procedures such as cystoduodenostomy are abandoned precisely because they leave the malignant-prone cyst lining in place. Cholecystectomy alone does not address the ductal dilatation.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.