A 5-year-old girl presents with intermittent right upper quadrant pain, a palpable cystic mass in the same region, and one episode of jaundice that resolved spontaneously. Ultrasound shows a fusiform dilatation of the common bile duct without intrahepatic dilatation. Definitive management is:
- A Internal drainage by cystoduodenostomy
- B Complete excision of the cyst with Roux-en-Y hepaticojejunostomy ✓
- C External drainage by cholecystostomy tube
- D Endoscopic sphincterotomy and stenting
Correct answer: B. Complete excision of the cyst with Roux-en-Y hepaticojejunostomy
Explanation
The classical triad of abdominal pain, palpable mass, and jaundice with fusiform extrahepatic duct dilatation defines a Todani type I choledochal cyst, the commonest type. Complete excision with Roux-en-Y hepaticojejunostomy is definitive because retained cyst mucosa carries a high lifetime risk of cholangiocarcinoma. Internal drainage procedures such as cystoduodenostomy leave the premalignant cyst lining behind and have been abandoned.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.