Residual Intrapancreatic Choledochal Cyst Following Incomplete Excision: A Case Report

Choledochal Cysts (CCs) are rare, congenital anomalies characterised by dilatation of the biliary tract that predominantly affect young individuals. Surgical excision is the cornerstone of treatment; however, incomplete resection may predispose patients to serious complications, including recurrent cholangitis, pancreatitis, hepaticojejunostomy stricture, intrahepatic stone formation, and even malignant transformation. We report a 48-year-old woman who presented with a two-year history of recurrent upper abdominal pain and vomiting, ten years after excision of a CC with Roux-en-Y hepaticojejunostomy and sixteen years after an open cholecystectomy. Contrast-Enhanced Computed Tomography (CECT) demonstrated residual intrapancreatic CC containing calculi. At reoperation, the main portal vein was tracked, and a residual cyst extending into the intrapancreatic region was identified and completely excised, preserving the previous Roux-en-Y hepaticojejunostomy. The cyst contained pus and stones, and histopathological examination showed mucosal inflammation with hyperplasia, consistent with CCs. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. She remained asymptomatic at six months of follow-up. This case underscores that complete excision of the intrapancreatic component at the index operation is essential to prevent long-term morbidity.