A giant choledochal cyst in a 17 year old female managed in a resource limited setting: A case report.

INTRODUCTION AND IMPORTANCE: Choledochal cysts are rare congenital bile duct anomalies that lead to cystic dilatations of the biliary tree. This condition is very rare in Africa. When these cysts exceed 10 cm in diameter, they are referred to as giant choledochal cysts, which are much rarer. Giant choledochal cysts present both a diagnostic and surgical challenge. We present a case of a giant Choledochal cyst surgically managed in a resource limited setting with excellent outcome. CASE PRESENTATION: A 17-year-old female presented with 4 months history of progressive abdominal distension associated with abdominal pain, yellow discoloration of eyes, and occasional constipation. Abdominal CT-scan revealed a huge cystic mass in the right upper quadrant extending inferiorly to the right lumbar region. Complete excision of a type IA choledochal cyst was done plus cholecystectomy in addition to bilioenteric reconstruction. The patient recovered uneventfully. DISCUSSION AND CONCLUSION: To the best of our knowledge, this is the largest giant Choledochal cyst reported in literature. Even in a resource limited settings, sonography and a CT scan may be all that is required to make a diagnosis. During surgical excision, the surgeon should take extra caution to carefully dissect the adhesions off the giant cyst for a successful complete excision.

Giant Choledochal Cyst in an Adult at a Teaching Hospital in South-Western Uganda: A Case Report.

BACKGROUND: Choledochal cysts are rare congenital malformations characterized by cystic dilatations of the biliary tree. They are more prevalent in East Asian populations, but uncommon in western countries, and scarcely reported in African nations. They are classically diagnosed in children, and only 20-30% of cases are diagnosed in adulthood. Giant choledochal cysts are those with sizes exceeding 10cm, and are extremely rare with a few reported in the literature, thus the need for this case report. CASE: A 25-year-old Ugandan woman presented with an 8-month history of abdominal pain, jaundice and progressively increasing right upper quadrant abdominal mass. She underwent trans-abdominal ultrasonography that revealed a large, well-defined, echo-free mass in the right upper quadrant, extending to the lumbar region. Abdominal computed tomography (CT) revealed a huge thin-walled, cystic mass rising from the right wall of common hepatic duct, displacing the surrounding structures and no visible common bile duct. Complete cyst excision of a giant choledochal cyst type IVa was performed without decompression, in addition to cholecystectomy and reconstruction with hepaticojejunostomy and jejunojejunostomy anastomoses. CONCLUSION: Giant choledochal cysts are a very rare pathology worldwide. Diagnosis can still be made using ultrasound and CT where more advanced imaging modalities like endoscopic retrograde cholangiopancreatography (ERCP) are not available. Complete surgical resection of giant choledochal cysts is surgically challenging, but essential to relieve symptoms and prevent malignant transformation. To the best of our knowledge, this is the first reported case in the literature, of a giant choledochal cyst that was successfully treated in an African nation.