A choledochal cyst in an 18-year-old girl with diagnostic challenges, and outcome of surgery with a tailored procedure: A case report.

INTRODUCTION: A choledochal cyst is a congenital malformation of the biliary tree which may remain asymptomatic and might manifest with atypical symptoms. We reported a missed cyst with a complicated presentation with imaging dilemmas and a satisfactory outcome of a tailored surgery.

PRESENTATION OF CASE: An 18-year-old girl following cholecystectomy one and a half years ago, presented to us with post-cholecystectomy syndrome. MRI suggested a large cystic structure in the region of the gall bladder containing a stone within. However, it revealed a choledochal cyst during surgery with extreme periportal adhesions. Partial excision of the cyst and Roux-en-Y choledocho-jejunostomy were performed at their finest to combat perioperative complications.

DISCUSSION: The diagnosis of a choledochal cyst is mostly based on imaging. But the imaging interpretation in a post-operative case is challenging. Total excision of the cyst in a complicated case might be impossible. Partial excision or cyst mucosectomy and cystoenterostomy are recommended in difficult cases.

CONCLUSION: Any previous biliary surgery increases the risk of complications; therefore, specialized hepatobiliary support is required. And it is recommended to tailor the definite surgery in a complicated situation.