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Case of the Month

March 2011

Patient Data: 1 year old female patient

Clinical Info: Acute abdominal pain and signs of peritonitis

Abnormal common bile duct and peritoneal fluid

Another image of the abnormal common bile duct and peritoneal fluid

37299-8971048_20100614_ABDOMEN-__0001.AVI.SWF videoclip of the abnormal common bile duct

37300-8971048_20100614_ABDOMEN-__0002.AVI.SWF Another videoclip of the abnormal common bile duct

Normal flow in the portal vein, but no flow in the dilatated common bile duct

Transverse image of the comon bile duct

Another transverse image of the abnormal common bile duct. There is a normal gallbladder

There is a lot of peritoneal fluid

Because we found only an abnormal wide common bile duct and no dilatated intrahepatic ducts and no dilatated gallbladder we concluded that there was probably a choledochal cyst. We could find no other explanation for the peritoneal fluid. A puncture of the fluid showed that it was bilious fluid. Because a ruptured choledochal cyst was suspected the patient was referred to a pediatric university hospital where the patient was operated. The final diagnosis was a ruptured choledochal cyst.

For more examples of choledochal cysts (in adults) and biliary pathology in children see

Spontaneous rupture of extrahepatic choledochal cyst: two pediatric cases and literature review.
Arda IS, Tuzun M, Aliefendioglu D, Hicsonmez A.
Eur J Pediatr Surg. 2005 Oct;15(5):361-3. Review.

Spontaneous perforation of choledochal cyst: a study of 13 cases.
Ando K, Miyano T, Kohno S, Takamizawa S, Lane G.
Eur J Pediatr Surg. 1998 Feb;8(1):23-5.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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