Clin Endosc.  2022 Jul;55(4):564-569. 10.5946/ce.2019.176.

A remnant choledochal cyst after choledochal cyst excision treated with a lumen-apposing metal stent: a case report

• Kim BK
• Chun JW
• Lee SH
• Ryu JK
• Kim YT
• Paik WH

• KMID: 2531951
• DOI: http://doi.org/10.5946/ce.2019.176

Abstract

A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

Keyword

Choledochal cyst; Endosonography; Self-expandable metallic stents

Figure

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  Fig. 1. (A) Abdominal computed tomography and (B) magnetic resonance cholangiopancreatography taken at initial presentation. Huge cystic dilatation of the common bile duct with bilateral intrahepatic duct dilatation and abrupt luminal diameter change in the peripheral duct was observed, suggestive of choledochal cyst, type IVa.

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  Fig. 2. (A) Abdominal computed tomography showed the remnant choledochal cyst after choledochal cyst excision. (B, C) Endoscopic ultrasonography-guided cystoduodenostomy at the second portion of the duodenum with a plastic stent was performed.

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  Fig. 3. Abdominal computed tomography showed (A) an increase in the size of the remnant choledochal cyst and (B) wall thickening with air-fluid level suggestive of cyst infection. (C) Endoscopic retrograde cholangiopancreatography showed the distorted pancreatic duct compressed by the remnant choledochal cyst. Endoscopic retrograde pancreatic drainage was done. Bile duct cannulation failed.

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  Fig. 4. (A, B) Cystoduodenostomy stent revision was done with a lumen-apposing metal stent. The previously inserted pancreatic stent was also noted.

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  Fig. 5. Drainage of the remnant choledochal cyst with lumen-apposing metal stent (LAMS). (A) Abdominal computed tomography taken 6 months after LAMS insertion showed an interval decrease in the size of the infected cyst. LAMS was subsequently removed. (B) Abdominal computed tomography taken 1 year after LAMS removal showed resolution of the remnant cyst.

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