Hospital: Complejo Asistencial Universitario Salamanca.
Aut@r o Autores: A. Verdú Segui, A. Sagredo Barra, S. Yáñez Castaño, P. Arias Rodríguez, C. González Donadeo, M. Maciá Fernández.
A 2-year-old-girl was admitted with vomiting and a decreased level of consciousness. Past medical history includes hypertransaminasemia and cyclical vomiting. On examination, she looked healthy and had no fever. She also presented with metabolic alkalosis and a high ketone level in the blood. Treatment for vomiting and hydration was started. Within 48 hours the patient deteriorated with fever, intense abdominal pain, and an elevation of serum lipase and amylase. An abdominopelvic ultrasound was performed which showed a 2.5 cm dilation of the extrahepatic bile duct with ascites. After this, an abdominopelvic contrast CT revealed a fusiform dilatation of extrahepatic bile duct (3,3 x 5,5 cm) without evidence of gallstones, a proximal intrahepatic duct dilatation, a diffuse pancreatic parenchymal enlargement with multifocal parenchymal necrosis and a large volume of ascites. These findings were compatible with a choledochal cyst (type IC Todani´s classification) with acute pancreatitis associated.
- Choledochal cyst is a congenital bile duct anomaly that mainly affects the extrahepatic bile duct. - Choledochal cysts are more common in female infants. - Classic clinical presentation includes abdominal pain, obstructive jaundice and palpable mass i
Choledochal cysts are a rare disease entity. It´s important to know the specific findings in the imaging tests and correlate it with the clinic in order to make a good differential diagnosis and avoid secondary complications (like malignancy, pancreatitis, biliary lithiasis, etc.).
- Soares KC, Arnaoutakis DJ, Kamel I , Rastegar N, Anders R , Maithel S, et al. Choledochal Cysts: Presentation, Clinical Differentation and Management. NIHPA . December 2014 , 219 (6):1167-1180. - Tommolino E, Michael HP, Talavera F, Anand BF, Sawyer MA