Wang ZM, Su S, Ling-Hu EQ, Chai NL. Type III choledochal cyst confirmed by aspiration and treated with endoscopic fenestration plus internal drainage: A case report. World J Gastrointest Surg 2025; 17(4): 104102 [DOI: 10.4240/wjgs.v17.i4.104102]
Corresponding Author of This Article
Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology, The First Medical Center of Chinese People’s Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104102 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104102
Type III choledochal cyst confirmed by aspiration and treated with endoscopic fenestration plus internal drainage: A case report
Zi-Meng Wang, Song Su, En-Qiang Ling-Hu, Ning-Li Chai
Zi-Meng Wang, School of Medicine, Nankai University, Tianjin 300071, China
Zi-Meng Wang, Song Su, En-Qiang Ling-Hu, Ning-Li Chai, Department of Gastroenterology, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Wang ZM and Su S were directly involved in patient care, collected the data and drafted the manuscript; Chai NL performed the endoscopic diagnosis and treatment procedures; Ling-Hu EQ supervised the treatment and critically revised the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology, The First Medical Center of Chinese People’s Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Received: December 16, 2024 Revised: January 12, 2025 Accepted: February 17, 2025 Published online: April 27, 2025 Processing time: 106 Days and 0.2 Hours
Abstract
BACKGROUND
Type III choledochal cysts (CCs) are extremely rare, and they present as dilatations and herniations of the end of the common bile duct into the duodenum. Moreover, type II CCs may be easily misdiagnosed as intraduodenal polyps or tumors. Thus, adequate differential diagnosis and selection of appropriate treatment are important.
CASE SUMMARY
A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization. After evaluation by magnetic resonance imaging and endoscopic ultrasonography, the duodenal papilla was pressed, and the bile flowed out slowly, which was speculated to be the cause of his symptoms. The lesion was punctured with a submucosal injection needle, and golden clear fluid was aspirated. Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin, direct bilirubin, amylase and lipase. Taken together, these findings confirmed that the lesion was a type III CC. The patient underwent fused surgical procedures. Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife. After drainage, the incision was sealed with tissue clips. During follow-up, the patient recovered well, and no abdominal pain symptoms or acute pancreatitis recurred.
CONCLUSION
Laboratory tests of cyst aspirates are beneficial for diagnosis, and endoscopic fenestration plus internal drainage works well to mitigate cysts.
Core Tip: In adults with duodenal masses, the possibility of choledochal cysts should be considered. Endoscopic puncture and laboratory examination of aspirates can effectively assist in clarifying the diagnosis. For patients who refuse surgical treatment, endoscopic fenestration plus drainage is a safe, minimally invasive option that provides effective symptomatic relief. Furthermore, long-term periodic follow-up and monitoring utilizing serological tests and imaging are essential.
