Unveiling Type 4A Choledochal Cyst a Congenital Anomaly Presenting in Adulthood: A Surgical Challenge

Rare congenital biliary tree malformations known as choledochal cysts can have a substantial negative impact on morbidity and mortality if they are not detected and treated promptly. The dilatation of either the intrahepatic or extrahepatic bile ducts, or both, is a characteristic of these cysts. Asian populations are more likely to have choledochal cysts; in Japan, the frequency is as high as one in per 1000 live births. There are 5 subtypes of choledochal cyst and in adults type 4 is the most common. Here we report a case of a 52-year-old lady who presented with vague abdominal pain and on evaluation was incidentally found to have a choledochal cyst type 4A. The patient underwent excision of the extrahepatic hugely dilated choledochal cyst with cholecystectomy and reconstruction was done by Roux-en-Y hepaticojejunostomy to the confluence of the right and left hepatic duct at the hilum.