PMC10034790_01
(a) layer of bile and biliary sludge over bowel and gallbladder. (b) Calculi and sludge seen at the ruptured anterior wall of choledochal cyst (at suction tip). (c) Ruptured choledochal cyst with visualised hepatic duct orifice, necrosed edges of choledochal cyst (arrow)
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Bowel was covered with greenish layer of bile [Figure 1a]. Biliary sludge and calculi helped in identifying ruptured CDC (type 1B) [Figure 1].
Sloughed out anterior wall of choledochal cyst with necrotic margins (black arrow), posterior wall of choledochal cyst is dissected free from portal vein (yellow arrow). Distal narrow end (white arrow) and proximally hepatic duct orifice at the confluence is seen. GB: Gallbladder
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The anterior wall of CDC was found ruptured with sloughed-out necrotic edges [Figure 2]. Oedematous and thickened cyst wall were dissected from medial to lateral aspect, making it free from portal vein [Figure 2].