Abstract
Background
Choledochal cysts are uncommon congenital biliary duct dilatation involving either intra-hepatic, extra-hepatic ducts or both. The presentation varies among pediatric age groups compared to adults, in which pediatrics present mostly with jaundice whereas adults present with abdominal pain. It carries high-risk complications and related malignancy depending on the type of cyst. There were few reported cases of spontaneous rupture of choledochal cyst in adults.
Case Description
A 35-year-old female, medically and surgically free. Presented to Emergency Department with recurrent episodes of non-bilious vomiting for three weeks, managed conservatively. One day later, she presented with generalized abdominal pain with persistent vomiting. The patient mentioned a history of chronic abdominal pain for 6 years. On examination, the abdomen was tender all over with signs of peritonitis. A Computed Tomography scan revealed a septated intra-hepatic duct cyst measuring 9 x 11 cm. Therefore, she was taken to the operating room for exploratory laparoscopy, washout was done and drains were inserted. Afterward, Endoscopic Retrograde Cholangio-Pancreatography with sphincterotomy and stenting performed. Six weeks later, she underwent elective left hepatectomy and histopathology confirmed the choledochal cyst. She had an uneventful postoperative course with two weeks follow up with no complications.
Conclusion
Ruptured choledochal cyst is a rare presentation and high clinical suspicion is warranted in adult patients who present with a surgical abdomen along with a history of chronic abdominal pain. This case report represents the importance of conservative treatment before the definitive operation, to allow resolution of the peritonitis and lower the consequences.
Spontaneous gangrene and perforation of choledochal cyst: a rare presentation
