Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 107351
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.107351
Treatment of giant choledochal cysts with combined surgery and percutaneous transhepatic cholangial drainage: A case report
Dong-Dong Wang, Yong-Yue Du, Yong-Zhao Li, Wei Wang, Tian-Long Ma, Xue-Chao Xu, Chen Mi, Si-Yang Wang, Feng Cui, Yuan-Hua She, Man-Cai Wang, Han-Teng Yang
Dong-Dong Wang, Yong-Yue Du, Yong-Zhao Li, Wei Wang, Tian-Long Ma, Xue-Chao Xu, Chen Mi, Si-Yang Wang, Feng Cui, Yuan-Hua She, Man-Cai Wang, Han-Teng Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
Co-first authors: Dong-Dong Wang and Yong-Yue Du.
Co-corresponding authors: Man-Cai Wang and Han-Teng Yang.
Author contributions: Wang DD, Du YY, Wang MC, and Yang HT conceptualized and wrote the first draft; Wang DD, Du YY, Li YZ, Wang W reviewed and edited; Du YY, Ma TL, Xu XC, and Yang HT performed the surgery; Wang DD, Li YZ, and Wang W provided the pictures; Mi C, Wang SY, Cui F, She YH, and Wang MC critically revised the manuscript. All authors have read and approved the final manuscript. Wang DD and Du YY contributed equally to this manuscript as co-first authors. The reasons for designating Yang HT and Wang MC as co-corresponding authors are fourfold. Both co-corresponding authors were involved in the conceptualization and writing of the first draft. Yang HT guided the conceptualization and writing process of Wang DD and Du YY. Yang HT was primarily responsible for patient consultation and follow-up, and Wang MC was primarily responsible for the conceptualization and writing of the article. Both authors shared the same contributions.
Supported by Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital, No. CY2024-MS-B04; Gansu Provincial Natural Science Foundation Project, No. 24JRRA331; and the Traditional Chinese Medicine Research Project of Gansu Province, No. GZKZ-2024-26.
Informed consent statement: Informed written consent for publication of this report and any accompanying images was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Han-Teng Yang, MD, Chief Physician, Lecturer, Department of General Surgery, Lanzhou University Second Hospital, No. 82 Cuiying Gate, Chengguan District, Lanzhou 730030, Gansu Province, China. yanghanteng@126.com
Received: March 30, 2025
Revised: April 18, 2025
Accepted: May 9, 2025
Published online: June 27, 2025
Processing time: 62 Days and 2.9 Hours
Abstract
BACKGROUND

Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation. Type IV (which affects the intrahepatic and extrahepatic ducts) is the most common subtype in adults. Its clinical manifestations are diverse and the disease can potentially become malignant. Currently, the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis. However, the surgical operation for giant choledochal cysts is technically challenging.

CASE SUMMARY

Here, we present a case of a giant choledochal cyst in an 18-year-old female. The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography. The patient developed acute cholangitis, and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms. The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy, which successfully achieved excellent postoperative recovery.

CONCLUSION

Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts. Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.

Keywords: Choledochal cyst; Giant; Surgery; Percutaneous transhepatic cholangial drainage; Diagnosis; Case report

Core Tip: Giant choledochal cysts are exceedingly rare in clinical practice. Here, we report a case of an 18-year-old female with a massive choledochal cyst complicated with acute cholangitis. Magnetic resonance cholangiopancreatography was performed, which facilitated the attainment of a confirmatory diagnosis, while percutaneous transhepatic cholangial drainage combined with definitive surgical intervention resulted in successful clinical outcomes. The present case highlights the critical significance of advanced imaging modalities in the diagnosis of giant choledochal cysts and highlights the efficacy of staged management (drainage followed by excision) for giant choledochal cysts. And the benefits of artificial intelligence systems for surgery are also discussed. These results provide crucial insights that can be used to optimize future diagnostic and therapeutic strategies for this rare biliary disorder.