Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Clin Cases. Sep 16, 2026; 14(26): 126222
Published online Sep 16, 2026. doi: 10.12998/wjcc.126222
Preoperative cholangioscopic identification of traumatic type IVa choledochal cyst perforation after motor vehicle collision: A case report
Liana Ysabel Almendras Bautista, Michelle Lee, Kartik Devgan, Jaron Longo, Sylvia Singh, Kenaz Bakdash, Moiz Ahmed, Rohit Agrawal
Liana Ysabel Almendras Bautista, Department of Internal Medicine, University of Illinois Hospital and Health System, Chicago, IL 60612, United States
Michelle Lee, Kartik Devgan, Jaron Longo, Department of Internal Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
Sylvia Singh, Department of Internal Medicine, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, United States
Kenaz Bakdash, Department of Radiology, Radiology of Indiana, Indianapolis, IN 46256, United States
Moiz Ahmed, Department of Gastroenterology, Community Health Network, Indianapolis, IN 46219, United States
Rohit Agrawal, Department of Gastroenterology, Loyola University Medical Center, Maywood, IL 60153, United States
Author contributions: Bautista LYA, Ahmed M, and Agrawal R contributed to conceptualization and design; Bautista LYA, Lee M, Devgan K, Longo J, Singh S, Bakdash K, and Ahmed M contributed to data acquisition, analysis, interpretation; Bautista LYA, Lee M, Devgan K, Singh S, Ahmed M, and Agrawal R contributed to article drafting and review; Bautista LYA, Lee M, Devgan K, Longo J, Singh S, Bakdash K, Ahmed M, and Agrawal R contributed to final approval of article; Bautista LYA is the article guarantor.
AI contribution statement: AI tools (specifically Grammarly) were used solely for language editing and proofreading. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and its accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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).
Corresponding author: Liana Ysabel Almendras Bautista, MD, Department of Internal Medicine, University of Illinois Hospital and Health System, 1740 W Taylor St., Chicago, IL 60612, United States.
lianaysabelbautista@gmail.com
Received: July 28, 2026
Revised: September 7, 2026
Accepted: September 17, 2026
Published online: September 16, 2026
Processing time: 52 Days and 12.2 Hours
BACKGROUND
Choledochal cyst (CC) perforation is a rare and potentially life-threatening complication of an uncommon congenital biliary abnormality. There are few case reports in adults, especially in settings of traumatic injury. In all reports of traumatic CC perforation, the diagnosis was made during emergent laparotomy.
CASE SUMMARY
A 63-year-old female with right upper quadrant and epigastric abdominal pain following a motor vehicle collision presented to the emergency room, with imaging suggestive of choledocholithiasis without hepatic injury. Endoscopic retrograde cholangiopancreatography (ERCP) and direct cholangioscopy revealed a contained hemorrhage secondary to a perforated bile duct, which raised suspicion for perforated CC. This prompted evaluation with cholangiogram, and a cholecystostomy tube bridge to surgical excision of CC and hepaticojejunostomy. Intraoperative anatomical classification of the cyst and surgical pathology confirmed a perforated Type IVa CC, which was treated with surgical excision and Roux-en-Y hepaticojejunostomy and cholecystectomy. Symptoms did not reoccur within a three month follow-up period.
CONCLUSION
This case highlights the diagnostic value of adding cholangioscopy to ERCP in identifying occult biliary injury in hemodynamically stable patients presenting with right upper quadrant abdominal pain in settings of trauma, which was supported by extravasation on cholangiogram. Utilization of these tools can lead to prompt perioperative recognition and management.
Core Tip: Traumatic rupture or perforation of a previously undiagnosed choledochal cyst in an adult is a rare cause of biliary injury and may mimic common conditions such as choledocholithiasis. Hemobilia or trauma-associated biliary obstruction should raise suspicion for occult biliary tree injury. Endoscopic retrograde cholangiopancreatography combined with cholangioscopy can directly visualize subtle duct injuries not apparent on initial imaging. Cholecystostomy tube placement may be a helpful bridge to surgery by improving source control in clinically stable patients. Early evaluation with cholangioscopy can facilitate preoperative delineation of biliary anatomy, guiding early diagnostic accuracy of biliary cysts, excision, and reconstruction.
