Clinical profile, management, and outcomes of choledochal cysts in adults: experience from a tertiary care center in the Sub-Himalayan region

Background: Choledochal cysts (CDCs) are rare congenital anomalies of biliary system, and adult presentations are uncommon and pose diagnostic and surgical challenges, particularly in distinguishing type VI CDC, a rare variant involving isolated cystic dilation of the cystic duct. This retrospective observational study evaluates the clinical profile, imaging, surgical management, and outcomes of adult CDC cases. Methods: A retrospective review of 31 adult patients with CDCs from July 2021 to December 2024 was conducted. Data on demographics, clinical presentation, imaging findings, surgical approach, and postoperative outcomes were analyzed. Results: The mean age was 37.55 years (range: 16-73), with 83.87% female predominance. There were 20 (64.52%) type I, 1 (3.22%) type II, 9 (29%) type IV, and 1 (3.22%) type VI CDC, initially misclassified as type IVA. Roux-en-Y hepaticojejunostomy (RYHJ) was performed in 83.87% of cases, with 8% requiring Lilly’s technique. Postoperative complications included biochemical leaks (23.08%), pancreatic fistulas (7.69%), and bile leaks (7.69%), all managed conservatively. Conclusions: Complete cyst excision remains gold standard, preventing complications such as cholangitis and malignancy. Type VI CDCs are frequently misclassified, necessitating intraoperative reassessment for accurate diagnosis. MRCP though gold standard, has limitations, reinforcing need for surgeon awareness and intraoperative decision-making.