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Revista Española de Enfermedades Digestivas
Print version ISSN 1130-0108
Rev. esp. enferm. dig. vol.110 n.7 Madrid Jul. 2018
https://dx.doi.org/10.17235/reed.2018.5477/2018
PICTURE IN PATOLOGY DIGESTIVE
Type V biliary cyst with cystolithiasis
1Servicios de Cirugía General y Digestiva. Hospital Universitario Río Hortega. Valladolid, Spain
2Servicios de Radiología. Hospital Universitario Río Hortega. Valladolid, Spain
CASE REPORT
We present the case of a 40-year-old female who presented to the General Surgery clinic due to a single episode of abdominal pain which required a visit to the Emergency Department. The patient had undergone surgery during childhood due to the suspicion of a hepatic hydatid cyst. However, an intraoperative cholangiography identified a small, non-complicated biliary cyst. Therefore, a hepatic resection was not performed. The patient did not undergo follow-up of the lesion. A large intrahepatic biliary cyst of 50 x 40 x 35 mm (type V, Todani classification) 1 was identified via ultrasound; it originated from the right hepatic bile duct, with lithiasis inside. This finding was corroborated via nuclear magnetic resonance (NMR) (Fig. 1 and Fig. 2). Type V biliary cysts are infrequent and they usually consist of multiple intrahepatic cysts 1. Our patient presented with a large single intrahepatic cyst, which highlights the singularity of this case. In addition, cystolithiasis is a rare finding in biliary cysts, especially in type V 2. Both the hepatic analytical profile and tumor markers were normal. The patient had not suffered previous cholangitis episodes. Despite the fact that type V biliary cysts have a low risk of malignancy, the optimal management of these lesions is surgical resection. Nevertheless, a strict radiologic surveillance was decided upon due to the numerous family related issues that the patient was going through 3.
REFERENCES
1. Todani T, Watanabe Y, Toki A, et al. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 2003;10(5):340-4. DOI: 10.1007/s00534-002-0733-7 [ Links ]
2. Söreide K, Körner H, Havnen J, et al. Bile duct cysts in adults. Br J Surg 2004;91(12):1538-48. DOI: 10.1002/bjs.4815 [ Links ]
3. Sastry AV, Abbadessa B, Wayne MG, et al. What is the incidence of biliary carcinoma in choledochal cysts, when do they develop, and how should it affect management? World J Surg 2015;39(2):487-92. [ Links ]