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Case Reports in Surgery
Volume 2013, Article ID 821032, 4 pages
http://dx.doi.org/10.1155/2013/821032
Case Report

Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience

Division of Digestive Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia

Received 17 March 2013; Accepted 10 April 2013

Academic Editors: A. Cho, A. K. Karam, and M. Rangarajan

Copyright © 2013 Fransisca J. Siahaya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP) and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.