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Anomalous choledocho-pancretic ductal junction in a choledochal cyst: A case report

Jovanović Miodrag (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Bilanović Dragoljub (Kliničko-bolnički centar „Bežanijska kosa', Beograd)
Čolović Radoje B. (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Grubor Nikica M. (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Uglješić Milenko (Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincterand outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y jejunal limb was carried out. In February 1990, she was admitted to our Institution for jaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.

Keywords: choledochal cyst, anomalous bilio-pancreatic ductal junction