Percutaneous Transhepatic Biliary Decompression in An Adult with Complicated Type IVA Choledochal Cyst: A Case Report
DOI:
https://doi.org/10.26911/theijmed.2026.11.4.980Abstract
Background: Choledochal cysts are rare congenital abnormalities characterized by dilatations of the biliary tree. Adult patients frequently present with complications such as choledocholithiasis, cholangitis, pancreatitis, or recurrent intra-abdominal infection. Percutaneous transhepatic biliary drainage (PTBD) may provide temporary decompression in selected patients with complicated biliary disease when immediate definitive management is challenging. This case report aimed to describe the technical approach and short-term outcome of right-sided external PTBD in an adult with a complicated Todani type IVA choledochal cyst and to highlight its role as a temporizing biliary decompression strategy.
Case presentation: A 50-year-old woman with a Todani type IVA choledochal cyst involving the bilateral intrahepatic bile ducts, common hepatic duct, and common bile duct, together with choledocholithiasis, had undergone cholecystectomy and later laparotomy, abscess evacuation, biopsy, and adhesiolysis for pancreatitis and multiple intra-abdominal abscesses.
Results: Follow-up ultrasonography and magnetic resonance cholangiopancreatography showed persistent intrahepatic and extrahepatic biliary dilatation with heterogeneous contents suspicious for biliary infection. Right-sided external PTBD was performed through an intercostal approach under ultrasonographic and fluoroscopic guidance using local anesthesia without sedation. Cholangiography opacified both intrahepatic systems, the common hepatic duct, and the common bile duct. An 8-Fr pigtail catheter was placed in the dilated right intrahepatic biliary system. The procedure was technically successful without immediate complication. At 24 hours, approximately 80 mL of bile had drained, abdominal pain had decreased, and the patient remained hemodynamically stable.
Conclusion: External PTBD established short-term biliary drainage in this complex adult case. It may serve as a temporizing intervention but does not replace definitive treatment or long-term surveillance of the underlying type IVA choledochal cyst.
Keywords:
choledochal cyst, biliary decompression, percutaneous transhepatic biliary drainage, Todani type IVAHow to Cite
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