Presentation
13-year-old female diagnosed with prenatal cyst. Asymptomatic, denies episodes of abdominal pain, jaundice or any other symptomatology. Under surveillance for refusal to surgery.
Patient Data
Extrahepatic bile duct with diffuse dilatation from the common hepatic duct, common bile duct to its retropancreatic portion and cystic duct. Intrahepatic bile duct with focal dilation of the left hepatic ducts up to 5mm and right up to 6mm. Features represent a choledochal cyst type IVa.
Case Discussion
The patient had been diagnosed prenatally with a type I cyst according to Todani´s classification, which means that it only involves the extrahepatic bile duct, however a surgical procedure was refused at the time and she has been kept under surveillance every 4 months. Now, it has progressed to a type IVa choledochal cyst because it compromises both the intra and extrahepatic bile duct with predominance of the retroduodenal portion with a caliber up to 38 mm in the axial plane.
The clinical suspicion of choledochal cysts is highly variable and the patient has remained asymptomatic up to now, however the risk of abdominal pain and progression to malignancy exists if surgery continues to be denied.
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