"RARE RUPTURE: BLUNT ABDOMINAL TRAUMA REVEALS PREVIOUSLY UNDIAGNOSED CHOLEDOCHAL CYST IN A CHILD – A CASE REPORT" SURGERYJRRMMC@gmail.com

 

"RARE RUPTURE: BLUNT ABDOMINAL TRAUMA REVEALS PREVIOUSLY UNDIAGNOSED CHOLEDOCHAL CYST IN A CHILD – A CASE REPORT"

6

Philippines

Poster Exhibition only

Choledochal cyst rupture secondary to blunt abdominal trauma is a rare clinical entity, particularly in pediatric patients. Isolated common bile duct (CBD) injuries are uncommon; traumatic rupture of choledochal cyst in children is exceptionally rare. We report a case of an isolated CBD rupture associated with undiagnosed Type I choledochal cyst following blunt trauma in a child.

A 6-year-old male presented with right upper quadrant pain one hour following a fall from a height of five feet. The patient was hemodynamically stable, though FAST was positive. Contrast-enhanced abdominal CT revealed significant intraperitoneal fluid accumulation, a dilated CBD exceeding 4 cm, and a suspected wall defect with intraluminal hematoma formation. MRCP confirmed presence of Type I choledochal cyst exhibiting a 1.4 cm lateral wall rupture with associated bile leak.

Initial management involved resuscitation and intravenous antibiotics. Diagnostic laparoscopy confirmed bilious ascites and 3 cm defect on the lateral CBD. T-tube was placed at the site of perforation to facilitate biliary drainage, followed by peritoneal lavage. The patient experienced an uneventful postoperative recovery and was discharged on postoperative day five. Elective complete cyst excision, cholecystectomy, and Roux-en-Y hepaticojejunostomy were performed one month later, with no complications. Histopathological analysis confirmed a benign lesion consistent with a choledochal cyst.

High index of suspicion for biliary injury in pediatric blunt abdominal trauma is paramount. A staged approach—initial minimally invasive drainage followed by delayed definitive surgery—is a safe and effective strategy for traumatic choledochal cyst rupture, minimizing risks of emergency biliary reconstruction within an inflamed field.