Abstract
Development of carcinoma from the remnant bile duct after cyst excision is a critical issue in the surgical management of congenital choledochal cyst. We report a case in which carcinoma from the remnant intrapancreatic bile duct developed 23 years after excision of a congenital choledochal cyst. A 69-year-old woman with a history of excision for a congenital choledochal cyst at age 46 presented with a mass in the pancreatic head detected by abdominal ultrasonography. Abdominal CT showed a cystic mass measuring 28 mm in diameter ; an enhanced nodule was detected in this lesion. ERCP revealed pancreaticobiliary maljunction with a dilated remnant intrapancreatic bile duct ; filling defects, caused by the nodule and mucin, were seen within the bile duct. Under the tentative diagnosis of carcinoma of the remnant intrapancreatic bile duct, substomach-preserving pancreaticoduodenectomy was performed. The patient remains alive and well with no evidence of disease 6 months after the resection. This case and a review of the literature suggest that careful long-term follow-up is necessary for patients undergoing excision for a congenital choledochal cyst.
