Surgical management of type IIIA choledochocele: insights from a case report

Introduction: A choledochocele (Todani type III) is a rare choledochal cyst that protrudes into the duodenum. Although the risk of malignancy is lower than in other choledochal cyst types, dysplasia and carcinoma have been reported, supporting the need for definitive treatment and histological assessment in selected patients. Presentation of case: A 16-year-old male presented with 5 months of meal-related epigastric pain and postprandial vomiting. Computed tomography and magnetic resonance cholangiopancreatography demonstrated a cystic lesion within the second portion of the duodenum that communicated with the distal common bile duct, consistent with a large choledochocele. Duodenoscopy confirmed a bulging lesion, but the papillary orifice could not be identified, precluding safe endoscopic therapy. The patient underwent open transduodenal excision and sphincteroplasty. Postoperative recovery was uneventful. Histopathology showed benign mucosa without dysplasia or malignancy. Discussion: Endoscopic sphincterotomy or unroofing is commonly used for type III choledochoceles, but large lesions and unclear papillary anatomy may make endoscopic treatment unsafe. In such cases, transduodenal excision provides definitive management and allows histological evaluation. Conclusion: In cases of large choledochoceles in which endoscopic identification of the papilla has failed, surgical transduodenal excision is a safe and definitive option.