Ann Hepatobiliary Pancreat Surg.  2022 Aug;26(3):281-284. 10.14701/ahbps.22-011.

Simultaneous laparoscopic removal of a Todani type II choledochal cyst and a microlithiasic cholecystitis

• Grottesi A
• Iacovitti S
• Ciano P
• Borrini F
• Zippi M

• KMID: 2532646
• DOI: http://doi.org/10.14701/ahbps.22-011

Abstract

Diverticula of the choledochus, better known as Todani type II cysts, are very rare and represent a predominantly pediatric pathology. Their identification by radiological methods, even if occasional, requires clinical doctors to request a surgical consultation, even for asymptomatic subjects, to proceed with their removal, given the risk of associated neoplasms. The laparoscopic approach for surgical treatment of these cysts has been recently introduced with excellent results. Due to the poor clinical records, currently there are neither shared protocols about their management nor long-term follow-up of operated patients. We report a case of an adult female suffering for years from biliary colic due to the presence of a duodenal diverticulum associated with microlithiasis’ cholecystitis, who was laparoscopically treated, with excellent results in terms of symptomatic regression, reduced hospitalization, and no surgery-related complications.

Keyword

Choledochal cyst; Laparoscopy; Surgical procedures

Figure

• 

  Fig. 1 Preoperative images. Microcalculations in the gallbladder lumen (arrow), associated with biliary sludge on ultrasound (A), and a Todani type II (arrow) with a 2-cm-wide peduncle, with relative insertion below the cystic duct on resonance (B).

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  Fig. 2 Intraoperative images. Gallbladder (white arrow) and Todani type II cyst (yellow arrow) on laparoscopic view (A); closure of the lozenge of the main bile channel with absorbable monofilament (white arrows) (B, C); anatomical structures just excised, gallbladder at the top and cyst at the bottom (D), where the diverticulum’s peduncle (yellow arrow) ending with the biliary lozenge can be seen.

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  Fig. 3 Pathological images of the surgical specimens after formalin fixation, showing the gallbladder (A) and Todani type II cyst (B) with its pedicle (yellow arrow).

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  Fig. 4 Histological slides (H&E, ×20). Chronic cholecystitis (A) with cholesterol deposits (yellow arrow), normal biliary epithelium of the wall of the diverticulum (B), as well as of the lozenge of the common bile duct (C).

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