PMC2259372_01
Computer tomography scans: Upper panel: A large cyst,11 cm in diameter, was considered to represent a common hepatic cyst because it was in direct contact with the liver. Lower panel: The dilated distal common bile duct was also misinterpreted as a second hepatic cyst.
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F1
Computer tomography showed a clearly limited, hypodense, homogenous structure with a transverse diameter of 11 cm in the immediate vicinity of the liver, anterior to the right kidney, and posterior to the gall bladder (Fig. 1, upper panel). The smaller structure was judged as an independent hepatic cyst because it resembled the large cyst, except for its smaller size (Fig. 1, lower panel).
Intraoperative situs: The choledochal cyst was mobilized and fixed with holding sutures. Clips are seen in the cyst, which closed the right and left hepatic ducts.
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F2
Todani type 1A, with a diameter of 8-10 cm was found (Fig. 2). The distal end of the stent was palpable in the duodenum, whereas the other end was visible in the fenestrated cyst (Fig. 2). After further exploration of the choledochal cyst, the clips became visible in the cyst (Fig. 2). However, these clips had not closed the suspected fistular ducts, but had occluded the right and left hepatic ducts (Fig. 2).
Resected specimen: The gallbladder (left) and the deflated bile duct cyst were removed (right).
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F3
The cyst was completely excised and the distal common bile duct was closed (Fig. 3).