Case Report
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World J Gastroenterol. Jun 28, 2013; 19(24): 3911-3914
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3911
Traumatic rupture of a type IVa choledochal cyst in an adult male
Yun-Fei Duan, Bo Yang, Feng Zhu
Yun-Fei Duan, Bo Yang, Feng Zhu, Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu Province, China
Author contributions: Duan YF and Yang B managed the patient and wrote the manuscript; Duan YF and Zhu F revised the manuscript; all authors have read and approved the final version to be published.
Correspondence to: Feng Zhu, PhD, Chief, Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou 213003, Jiangsu Province, China. dahe1971@163.com
Telephone: +86-519-68871348 Fax: +86-519-86621235
Received: February 16, 2013
Revised: March 26, 2013
Accepted: April 10, 2013
Published online: June 28, 2013
Processing time: 132 Days and 2 Hours
Abstract

Choledochal cyst (CC) is a rare, congenital anomaly of the bile ducts. We describe a 26-year-old male patient who was transferred to our hospital with a reported traumatic rupture of cystic liver lesions following a fall. At the time of injury, the patient experienced severe abdominal pain. He was found to have peritonitis and abdominal hemorrhage, which is quite rare. Laparotomy revealed 3000 mL fluid consisting of a mixture of blood, bile and inflammatory effusion in the peritoneal cavity. The liver, gallbladder, spleen, stomach, duodenum, small intestine, and colon appeared normal. A large cystic mass was discovered near the porta hepatis. This mass, which connected to the hepatic bifurcation and gallbladder had a 5 cm rupture in the right wall with active arterial bleeding. Abdominal computed tomography (CT) and emergency laparotomy revealed rupture of a huge type IVa CC. The patient was successfully managed by primary cyst excision, cholecystectomy, and Roux-en-Y end-to-side hepaticojejunostomy reconstruction. The postoperative course was uneventful and the patient was discharged on the 12th day of hospitalization. Four weeks after surgery, abdominal CT scan showed pneumatosis in the intrahepatic bile duct, and intrahepatic dilatation which decreased following adequate biliary drainage. The patient has remained well in the close follow-up period for 9 mo.

Keywords: Biliary tract, Choledochal cyst, Trauma, Rupture, Peritonitis, Hemorrhage

Core tip: Choledochal cyst (CC) is a rare, congenital anomaly of the bile ducts. We describe a young man who was transferred to our hospital with a reported traumatic rupture of liver cystic lesions. The patient was found to have peritonitis and abdominal hemorrhage, which is quite rare. Abdominal computed tomography and emergency laparotomy revealed rupture of a huge type IVa CC. The patient was successfully managed by primary cyst excision, cholecystectomy, and Roux-en-Y end-to-side hepaticojejunostomy reconstruction.