Treatment of giant choledochal cysts with combined surgery and percutaneous transhepatic cholangial drainage: A case report

Figure 1 Abdominal magnetic resonance imaging scanning findings at first admission. A: Representative magnetic resonance image of the upper abdomen (coronal view) reveals multiple cystic dilations of intrahepatic and extrahepatic bile ducts, suggesting type IV-A congenital biliary cystic dilation; B: The magnetic resonance image of the upper abdomen (axial view).

Figure 2 Magnetic resonance cholangiopancreatography findings at first admission. A: A round filling defect was detected at the base of the dilated bile duct, suggesting the presence of a stone (white arrow); B: Magnetic resonance cholangiopancreatography revealed cystic dilation of the intrahepatic bile ducts (black arrow), accompanied with extreme dilation of the common hepatic duct and common bile duct (white arrows), presenting as a large cystic expansion. Hydronephrosis was also visualized (blue arrow); C: Magnetic resonance cholangiopancreatography demonstrated gallbladder atrophy (white arrow), narrowing of the cystic duct (blue arrow), and dilatation at the junction of the cystic duct and common hepatic duct (black arrow); D: Diffusion-weighted imaging identified a layered appearance within the cyst, with the lower layer suggesting bile sludge deposition based on its location and shape (white arrow).

Figure 3 Changes in color and properties of percutaneous transhepatic cholangial drainage fluid. A: The drainage fluid collected on the day of percutaneous transhepatic cholangial drainage surgery appearing dark and turbid; B: A clear drainage fluid was obtained on the first fast discharge, closely resembling normal bile; C: The drainage fluid collected during the second hospitalization for surgical treatment was clear, consistent with normal bile.

Figure 4 Abdominal magnetic resonance imaging findings at second admission. A: Resolution of hydronephrosis (white arrow); B: Persistent dilatation of intra- and extrahepatic biliary ducts (white arrow); C: There was significant reduction in abdominal cyst size (white arrow); D: Key anatomical structures of the abdomen. GB: Gall bladder; CC: Choledochal cyst; PV: Portal vein; AA: Abdominal aorta.

Figure 5 Postoperative pathological findings (dyeing method: Hematoxylin and eosin stain; magnifying power: 100 ×). Examination of the surgical specimen: The submitted cyst wall presented with fibrous tissue hyperplasia, lined with a single layer of columnar epithelium, with some areas of epithelial detachment, and interstitial inflammatory cell infiltration, which suggested the presence of a choledochal cyst combined with acute and chronic inflammation.