Choledochal Cyst Todani Classification Type IC and Choledocholithiasis Presenting as Recurrent Pancreatitis in a 7-Year-Old Girl – A Case Report
DOI:
https://doi.org/10.58427/apghn.5.1.2026.28-36Keywords:
autoimmune pancreatitis, biliary obstruction, hepaticojejunostomy, laparoscopic surgery, magnetic resonance cholangiopancreatographyAbstract
Background: Choledochal cyst is an uncommon but important cause of biliary pathology in the pediatric population which can lead to choledocholithiasis and recurrent pancreatitis. High clinical suspicion, comprehensive imaging, and multidisciplinary evaluation are essential for accurate diagnosis and treatment. Definitive management is achieved through surgical intervention.
Case: A 7-year-old girl experienced recurrent postprandial right upper quadrant and epigastric pain for three years, with fluctuating pancreatic and hepatic enzymes. Initial ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed ductal dilatation with biliary sludge, while multislice computed tomography (MSCT) suggested autoimmune pancreatitis, leading to temporary steroid response. Symptoms persisted, and contrast-enhanced magnetic resonance imaging (MRI) demonstrated fusiform common bile duct dilatation with debris, confirming Todani type IC choledochal cyst and choledocholithiasis. She underwent laparoscopic cyst and gallbladder excision with Roux-en-Y hepaticojejunostomy. Intraoperative and histological findings verified sludge, gallstones, and chronic cholecystitis.
Discussion: Choledochal cysts should be considered in pediatric recurrent pancreatitis, particularly with biliary obstruction. Advanced imaging and differential diagnosis are crucial. Surgical excision with biliary reconstruction is the treatment of choice.
Conclusion: Early recognition and timely surgical intervention are essential to prevent long-term complications.
References
Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S, Pawlik TM. Choledochal cysts: Presentation, clinical differentiation, and management. J Am Coll Surg. 2014;219(6):1167-80. https://doi.org/10.1016/j.jamcollsurg.2014.04.023 DOI: https://doi.org/10.1016/j.jamcollsurg.2014.04.023
Dira IKPA, Putra IGNS, Karyana IPG, Nesa NNM, Ariyanta KD, Dharmajaya IM. Choledochal cyst (cc) todani type i in two years old girl: A case report. Intisari Sains Medis. 2023;14(3). DOI: https://doi.org/10.15562/ism.v14i3.1839
Abu-El-Haija M, Kumar S, Szabo F, Werlin S, Conwell D, Banks P, Morinville VD. Classification of acute pancreatitis in the pediatric population: Clinical report from the naspghan pancreas committee. J Pediatr Gastroenterol Nutr. 2017;64(6):984-90. https://doi.org/10.1097/mpg.0000000000001583 DOI: https://doi.org/10.1097/MPG.0000000000001583
Tsai PH, Yen YC, Chou YH, Lin CH, Bai YL, Kao SC, et al. Type i choledochal cyst complicated with acute hemorrhagic pancreatitis: A case report. J Med Ultrasound. 2017;25(4):235-9. https://doi.org/10.1016/j.jmu.2017.09.003 DOI: https://doi.org/10.1016/j.jmu.2017.09.003
Poffenberger CM, Gausche-Hill M, Ngai S, Myers A, Renslo R. Cholelithiasis and its complications in children and adolescents: Update and case discussion. Pediatr Emerg Care. 2012;28(1):68-76; quiz 7-8. https://doi.org/10.1097/PEC.0b013e31823f5b1e DOI: https://doi.org/10.1097/PEC.0b013e31823f5b1e
Ma MH, Bai HX, Park AJ, Latif SU, Mistry PK, Pashankar D, et al. Risk factors associated with biliary pancreatitis in children. J Pediatr Gastroenterol Nutr. 2012;54(5):651-6. https://doi.org/10.1097/MPG.0b013e31823a897d DOI: https://doi.org/10.1097/MPG.0b013e31823a897d
Restrepo R, Hagerott HE, Kulkarni S, Yasrebi M, Lee EY. Acute pancreatitis in pediatric patients: Demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol. 2016;206(3):632-44. https://doi.org/10.2214/ajr.14.14223 DOI: https://doi.org/10.2214/AJR.14.14223
Kandula L, Lowe ME. Etiology and outcome of acute pancreatitis in infants and toddlers. J Pediatr. 2008;152(1):106-10, 10.e1. https://doi.org/10.1016/j.jpeds.2007.05.050 DOI: https://doi.org/10.1016/j.jpeds.2007.05.050
Trout AT, Anupindi SA, Freeman AJ, Macias-Flores JA, Martinez JA, Parashette KR, et al. North american society for pediatric gastroenterology, hepatology and nutrition and the society for pediatric radiology joint position paper on noninvasive imaging of pediatric pancreatitis: Literature summary and recommendations. J Pediatr Gastroenterol Nutr. 2021;72(1):151-67. https://doi.org/10.1097/mpg.0000000000002964 DOI: https://doi.org/10.1097/MPG.0000000000002964
Wang C, Fu B, Su D, Huang P, Fu X. Acute pancreatitis and recurrent acute pancreatitis in children: A 10-year retrospective study. Gastroenterol Res Pract. 2022;2022:5505484. https://doi.org/10.1155/2022/5505484 DOI: https://doi.org/10.1155/2022/5505484
Weng SC, Lee HC, Yeung CY, Chan WT, Liu HC, Jiang CB. Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review. Pediatr Neonatol. 2020;61(6):598-605. https://doi.org/10.1016/j.pedneo.2020.07.013 DOI: https://doi.org/10.1016/j.pedneo.2020.07.013
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: Guidelines of the international association of pancreatology. Pancreas. 2011;40(3):352-8. https://doi.org/10.1097/MPA.0b013e3182142fd2 DOI: https://doi.org/10.1097/MPA.0b013e3182142fd2
Okazaki K, Kawa S, Kamisawa T, Ikeura T, Itoi T, Ito T, et al. Amendment of the japanese consensus guidelines for autoimmune pancreatitis, 2020. J Gastroenterol. 2022;57(4):225-45. https://doi.org/10.1007/s00535-022-01857-9 DOI: https://doi.org/10.1007/s00535-022-01857-9
Gallo C, Dispinzieri G, Zucchini N, Invernizzi P, Massironi S. Autoimmune pancreatitis: Cornerstones and future perspectives. World J Gastroenterol. 2024;30(8):817-32. https://doi.org/10.3748/wjg.v30.i8.817 DOI: https://doi.org/10.3748/wjg.v30.i8.817
Pădureanu V, Drăgoescu AN, Pădureanu R, Rośu MM, Rădulescu D, Dop D, For Ofoiu MC. Treatment approaches in autoimmune pancreatitis (review). Biomed Rep. 2024;20(2):26. https://doi.org/10.3892/br.2023.1714 DOI: https://doi.org/10.3892/br.2023.1714
He X, Sun B, Nie Y, Zhang W. Recent advances in diagnosis, treatment, and prognosis of igg4-related autoimmune pancreatitis: A narrative review. Journal of Pancreatology. 2022;5(4):202-9. https://doi.org/10.1097/jp9.0000000000000112 DOI: https://doi.org/10.1097/JP9.0000000000000112
Freeman AJ, Maqbool A, Bellin MD, Goldschneider KR, Grover AS, Hartzell C, et al. Medical management of chronic pancreatitis in children: A position paper by the north american society for pediatric gastroenterology, hepatology, and nutrition pancreas committee. J Pediatr Gastroenterol Nutr. 2021;72(2):324-40. https://doi.org/10.1097/mpg.0000000000003001 DOI: https://doi.org/10.1097/MPG.0000000000003001
Vujasinovic M, Lindgren F, Kartalis N, Pozzi Mucelli R, Rutkowski D, Waldthaler A, et al. Pediatric autoimmune pancreatitis: Clinical findings and outcomes in sweden. United European Gastroenterol J. 2025;13(5):819-30. https://doi.org/10.1002/ueg2.70022 DOI: https://doi.org/10.1002/ueg2.70022
Holcomb GW III, Murphy JP, St. Peter SD. Choledochal cyst and gallbladder disease. Holcomb and ashcraft’s pediatric surgery. 7th ed. Philadelphia: Elsevier; 2020. p. 695–707.
Shimotakahara A, Yamataka A, Yanai T, Kobayashi H, Okazaki T, Lane GJ, Miyano T. Roux-en-y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: Which is better? Pediatr Surg Int. 2005;21(1):5-7. https://doi.org/10.1007/s00383-004-1252-1 DOI: https://doi.org/10.1007/s00383-004-1252-1
Liem NT. Laparoscopic surgery for choledochal cysts. J Hepatobiliary Pancreat Sci. 2013;20(5):487-91.https://doi.org/10.1007/s00534-013-0608-0 DOI: https://doi.org/10.1007/s00534-013-0608-0
Sun R, Zhao N, Zhao K, Su Z, Zhang Y, Diao M, Li L. Comparison of efficacy and safety of laparoscopic excision and open operation in children with choledochal cysts: A systematic review and update meta-analysis. PLoS One. 2020;15(9):e0239857. https://doi.org/10.1371/journal.pone.0239857 DOI: https://doi.org/10.1371/journal.pone.0239857
Kowalski A, Kowalewski G, Kaliciński P, Pankowska-Woźniak K, Szymczak M, Ismail H, Stefanowicz M. Choledochal cyst excision in infants-a retrospective study. Children (Basel). 2023;10(2). https://doi.org/10.3390/children10020373 DOI: https://doi.org/10.3390/children10020373
Yan J, Lv C, Zhang D, Zheng M, Peng C, Pang W, et al. Management of complicated choledochal cyst in children: Ultrasound-guided percutaneous external drainage and subsequent definitive operation. BMC Pediatr. 2023;23(1):266. https://doi.org/10.1186/s12887-023-03994-3 DOI: https://doi.org/10.1186/s12887-023-03994-3
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