Giant Choledochal Cysts in a 2 Year Old Child

The cystic dilatation of the common bile duct is a rare pathology. It is the second surgical case of cholestasis icterus in infants after biliary duct atresia. It still poses problems of differential diagnosis and treatment. A girl aged 2 years has been admitted in our department for exploration of an abdominal distension. The physical examination has shown the presence of a large mass at the level of the hypochondria and the right flank arriving to the umbilicus associated with a discrete icterus without other signs. Laboratory tests have been without anomalies except a hyperbiluribinémie. Abdominal ultrasound revealed a hepatic cyst measuring 11.6 in the segment 4 and 5 of the liver. A computerized tomography concluded to a large hepatic cyst with an important part under the liver arriving to the pelvis. Magnetic resonance cholangio-pancreatography confirmed the diagnosis of a large cystic dilatation of the common bile duct type 4 of Todani. At laparotomy, a giant cystic dilatation of the common bile duct going from the liver extending into the right abdominal part. She had had a total excision of the cystic dilatation of the common bile duct, carrying away the cystic duct and the gallbladder, with a bilio-digestive bypass installing a jejunal loop in Y.