Choledocal cyst type IV: a case report

Devi Pediatri, Evi Rokhayati, Bambang Soebagyo

Department of Child Health Medical School
Sebelas Maret University / Dr Moewardi Surakarta
Abstract
Background. Choledochal cysts (CCs) are congenital conditions involving cystic dilatation
of bile ducts with an incidence in the western population of 1 in 100 000150 000 live births.
The rate is remarkably higher in Asian populations with a reported incidence of 1 in 1000.
Classic triad of intermittent abdominal pain, jaundice, and a right upper quadrant abdominal
mass is found only in minority of patients.
Objective. To know the diagnostic approach and management.
Case. A 17 months old boy was admitted to dr. Moewardi hospital with the chief complaint
of a history of acholic stool in Februari 2015. The upper right quadran of abdomen was
palpable and he also had jaundice. The laboratory data revealed PT 11.4 second, APTT 24.7
second, Gamma GT 282 u/l, Alkali fosfatase 227 u/l, Total bilirubin 1.05 mg/dl, direct
bilirubin 0.88 mg/dl, indirect bilirubin 0.17 mg/dl. The ultrasonography examination showed
multiple capsulated anechoic lesions in the choledochal duct measured 3.40 cm and 0.80 cm
in diameters, we suspected for choledocal cysts. A MRCP examination was perfomed and
showed dilatation of ductus cysticus, ductus hepaticus and ductus hepaticus communis with
diagnosis of choledocal cyst type IV. Surgery is the treatment of choice for a choledochal
cyst, so we suggested surgery for him.
Conclusion Early diagnosis and therapy are important to get a good prognosis of choledocal
cyst type IV.
Keyword Choledocal cyst type IV, jaundice, cholestasis