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Synchronous Todani types I and III choledochal cysts in a 10-month-old-infant: type IVb

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Abstract

A 10-month-old, previously healthy boy presented with one week of mild jaundice, light-colored stools and irritability. Abdominal sonography showed a large type I choledochal cyst and a separate, distinct cystic mass at the head of the pancreas. Magnetic resonance cholangiopancreatography was performed to evaluate the relationship of the two lesions. A type I choledochal cyst was confirmed, and a coexisting type III choledochocele was identified as the second cystic structure in conjunction with pancreaticobiliary malunion. The infant had complete resection of the type I choledochal cyst with Roux-en-Y hepaticojejunostomy, and anterior duodenotomy with marsupialization of the choledochocele. After five years of follow-up, the child is thriving and has had no recurrence of his symptoms. An exhaustive review of the literature identifies only one previous case of synchronous types I and III choledochal cysts, and this association is not clearly defined among the traditional classifications of type IV multiple choledochal cysts. Because operative management of a type III cyst requires the addition of a transduodenal approach, we encourage accurate reporting of mixed type choledochal cysts for the benefit of surgical planning, epidemiologic tracking and outcomes.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA

    Oliver B. Lao

  2. Department of Pediatric Radiology, Vanderbilt University, Nashville, TN, USA

    Sharon Stein

  3. Department of Pathology, Vanderbilt University, Nashville, TN, USA

    Kim A. Ely

  4. Department of Pediatric Surgery, Vanderbilt University, Nashville, TN, USA

    Harold N. Lovvorn III

Authors
  1. Oliver B. Lao
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  2. Sharon Stein
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  3. Kim A. Ely
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  4. Harold N. Lovvorn III
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Correspondence to Oliver B. Lao.

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Lao, O.B., Stein, S., Ely, K.A. et al. Synchronous Todani types I and III choledochal cysts in a 10-month-old-infant: type IVb. Pediatr Surg Int 24, 859–862 (2008). https://doi.org/10.1007/s00383-008-2162-4

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  • DOI: https://doi.org/10.1007/s00383-008-2162-4

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