Adult Giant Choledochal Cyst Conundrum: A Case Report

Introduction: Choledochal cyst is rare malformation of the biliary system, characterized by abnormal cystic dilation in the biliary duct. There is no clear explanation regarding the etiology of the disease. Choledochal cysts are more common in Asian population, mainly diagnosed in children, particularly in females. Due to the rare incidence of giant choledochal cyst, evidence regarding safe operative approach was still scarce. This study aims to present the management option of type 1 giant choledochal cyst. Case presentation: We present a 26-year-old female patient with a chief complaint of intermittent right upper quadrant abdominal pain, which radiated to the back. The pain worsened while the patient was pregnant. The patient was then diagnosed with a giant choledochal cyst and concomitant left- and right- hepatic duct dilation with multiple gallstones. Results: We utilize Lilly’s technique, which involves cauterizing the mucosa while leaving the serosa connected to the adhering tissues. This method is helpful in giant long standing cyst, where the mucosa could not be entirely removed because it adhered to another structure, such as the pancreatic parenchyma, inferior vena cava, or hepatic hilar arteries. Conclusion: A complicated gigantic Type 1 choledochal cyst case benefits from Lilly’s method.