Todani Type 1B Choledochal Cyst in Two Cases of Choledochal Cyst in 2-Year-Old Children: A Rare Case with Biliary Reconstruction Using Roux-en-Y Hepaticojejunostomy
Dwi Wulandari *
Faculty of Medicine, Muhammadiyah Surabaya University, Surabaya, Indonesia.
Agung Budi Lemuel
Department of Surgery, General Surgery Division, Faculty of Medicine, Muhammadiyah Surabaya University, Surabaya, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Aims: To report cases of choledochal cyst, the flow of diagnosis, and the management of these cases.
Case Description: Two 2-year-old children who presented with abdominal mass, jaundice, abdominal discomfort, pale stools, and vomiting were found to have choledochal cysts. The results of the laboratory tests showed increased levels of SGOT and SGPT, as well as direct and total bilirubin. A type 1B choledochal cyst was indicated by abdominal ultrasonography, which revealed saccular dilatation of the common hepatic duct (CBD) extending to the proximal CBD without intrahepatic bile duct dilatation. Cystic duct dilatation, gallbladder wall edema, contrast enhancement, and a fusiform cystic lesion from the CHD to the CBD were all seen on an abdominal CT scan. Upon pathological examination, no carcinoma cells were found.
Discussion: Discussion: Although choledochal cysts, especially Todani type IB, have similar anatomical involvement, their clinical manifestations vary. Imaging is crucial for early diagnosis, and MRCP provides the best diagnostic accuracy. The preferred course of treatment is still surgical excision followed by Roux-en-Y hepaticojejunostomy. Complete resection reduces the risk of malignancy, but incomplete excision greatly raises it, underscoring the significance of early detection, thorough imaging, and careful surgical planning.
Conclusion: choledochal cysts must be identified early and surgically managed to avoid complications and lower the chance of malignant transformation.
Keywords: Choledochal cyst, hepaticojejunostomy, todani type 1b