Journal zyxwvutsrqpon of Gastroenterology and Hepatology (1996) zyxwvu 11, 847-849 BILIARY MASSES zyxw CASE REPORT: Giant choledochal cyst ANDREW JA HOLLAND* AND PHILIP A CHILDS Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia Abstract We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed. Key words: adult, giant choledochal cyst, long-term review. INTRODUCTION Choledochal cysts, defined as aneurysmal dilatations of the biliary tree, account for approximately 1% of all benign biliary disease.' They were first described by Vater in 1723,2 but remained unclassified until Alonso- Lej et ale3 reported two patients and reviewed 94 cases of choledochal cysts in 1959. This classification system was modified by Todani et aL4 in 1977, who added those types that involved cystic dilatation of both the extra and intrahepatic duct system. While the majority of cases present in children, nearly 20% of patients will first manifest as adult^.^ Physicians and general surgeons need to be familiar with this uncommon condition to ensure prompt diagnosis and appropriate definitive management. We report the case of a young woman with a rare giant type I choledochal cyst, who presented with the classical triad of jaundice, pain and an abdominal mass.6 CASE REPORT A previously well 19 year old woman developed intermittent right upper quadrant pain associated with nausea and anorexia while in the third trimester of her first pregnancy in 1982. Exacerbation of the pain occurred shortly after delivery of a normal infant and an oral cholecystogram was performed. This revealed a non-functioning gall-bladder. Over the subsequent 4 weeks her pain increased in frequency and severity and was associated with the passage of dark urine and further postpartum weight loss of 10 kg. The only past medical history was of appendicectomy and there was no relevant family history. On admission she was cachectic and jaundiced, with a rounded convex mass in the right upper quadrant extending down to the umbilicus. Liver function tests revealed an obstructive pattern. Hepatitis B serology was negative. An ultrasound scan revealed a giant choledochal cyst (Figs 1,2). Figure 1 Longitudinal ultrasound scan indicating large choledochal cyst (C), with dilated bile ducts (B). The liver (L) is seen superiorly, together with the gall-bladder (G) and diaphragm (arrow). Correspondence: Mr PA Childs, Department of General Surgery, Royal Perth Hospital, Box X2213, GPO, Perth, WA *Present address: Department of General Surgery, Fremantle Hospital, Fremantle, WA 6 160, Australia Accepted for publication 22 January 1996. 6001, Australia.