CHOLEDOCHAL CYST OF THE PROXIMAL COMMON PANCREATICOBILIARY CHANNEL

Choledochal cysts are aptly considered a manifestation of a basic abnormality of the extrahepatic ductal architecture not limited to the areas of cystic dilation. The modified classification system of Alonzo-Lej recognizes five variants by gross morphology. The goal of surgical treatment is generally viewed as biliary decompression and excision of all diseased ductal epithelium. We describe our management of a 22-month-old female with a distinct cystic expansion of the intrapancreatic common duct as well as proximal biliary dilations. Her surgical treatment consisted of excision of the extrahepatic biliary tree proximal to the intrapancreatic cystic portion and roux-en-Y portojejunostomy. This case extends the concept of ''choledochal cyst,'' and stresses the goals of surgical intervention with the importance of follow-up in patients whose particular anatomy prohibits total initial excision.