Iftikhar Ahmed, Iftikhar Ahmed, Mushahid Aslam, Aqeel Safdar, Safdar Hussain Awan, Adnan Khalid.
Huge Choledochal cyst.
Pak Armed Forces Med J Nov ;55(3):258-60.

A one year old girl with progressive abdominal distention, vague abdominal pain and intermittent low grade fever. There was no anorexia, jaundice or vomiting. Also there were no urinary or bowel complaints. Birth, developmental and family history was not significant On examination she weighed 10Kg with average physique, but was pale. Abdomen was diffusely distended with prominent veins. Hemoglobin was 7gm/ dl, with a total leucocyte count of 16000/cubic cm. Liver functions were slightly deranged and coagulation profile was within normal limits. Ultrasonography of abdomen showed about 18x20 cm sub hepatic cystic swelling separate from the liver. Hepatic texture was normal. CT scan abdomen revealed huge cystic swelling occupying most of the abdomen, displacing the gut. A diagnosis of choledochal cyst was suggested. Surgery was planned. Pre-operatively the patient was given blood, vitamin-k antibiotics and fluids. Abdomen was opened by supra-umbilical transverse incision. There was a fusiform (type-I) choledochal cyst measuring approximately 18x20cm is size. It was densely adherent to the surrounding structures, with colon plastered over its anterior wall and posteriorly to the portal vein .Its distal end was stenosed. Proximally cyst was extending up to the confluence of common hepatic duct (CHD). Cyst was excised in toto by Lilly`s method in which intra-mural resection (mucosectomy) was carried out leaving behind only the leash of tissue adherent to portal vein. Retro colic Roux-en-y-hepaticojejunostomy was carried out. Post-operative recovery was uneventful.

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