Choledocholithiasis and choledochal cyst

Discussion:

The patient presented with signs and symptoms consistent with cholelithiasis. Bloods indicated an obstructed picture. Ultrasound showed cholecystitis with choledocholithiasis in the setting of type 1 choledochal cyst. This was confirmed on follow up CT abdomen.

The patient progressed to an open cholecystectomy with bile duct clearance via open and choledochoscope. No leak was demonstrated and the wound was closed with a drain left in situ. She had increasing pain several days later. Unfortunately, she was unable to have MRCP as an unknown metal foreign body was in situ from overseas. 

The decision was made to progress to a CT cholangiogram. This showed no leak or residual stone. There was contrast seen progressing into the duodenum. Dilation of the intrahepatic bile duct changed the choledochal cyst from type 1 to a type 4A. 

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