Pediatric Congenital Biliary Dilatation With Giant Choledochal Cyst Complicated by Intraoperative Pancreatic Duct: A Case Report

Abstract

Here, we report the case of a 6-month-old girl with congenital giant biliary dilatation caused by pancreatic duct injury during the excision of the extrahepatic bile duct, including the repair strategy. Cholecystostomy was carried out because the choledochal cyst was dilated to 12 cm in diameter and obstructive jaundice occurred 5 months after birth, and then flow diversion operation was performed 6 months after birth. Intraoperative findings showed extrahepatic biliary duct dilatation, and intraoperative cholangiography showed pancreaticobiliary maljunction of Type Ia determined on the basis of the new Komi classification. The distal end of the cyst was buried in the parenchyma of the pancreas and was close to the main pancreatic duct on the tail side. On dissection, the main pancreatic duct was injured partially because of the tight adhesion between the bile duct inside the pancreas and the main pancreatic duct. After a percutaneous transgastroduodenal pancreatic duct drainage stent was inserted into the main pancreatic duct using the 3Fr. atom feeding catheter T (Atom Medical^®), an omentum patch was filled on the repaired site of the pancreatic duct, the pancreatic surface membrane was closed, hepaticojejunostomy was performed, and flow diversion operation was completed. Her postoperative course was satisfactory without pancreatic juice leakage and pancreatic duct stenosis and she was discharged 20 days after the operation, namely, excision of the extrahepatic bile duct and reconstruction.