Common bile duct cyst stone within a Todani Type II biliary cyst: A rare case report

Introduction Biliary cysts, previously known as choledochal cysts, are congenital dilatations of the biliary tree classified into five types. These anomalies present diagnostic and surgical challenges due to anatomical variations and potential complications. Purpose and objective This case report describes a rare presentation of a Todani Type II biliary cyst containing gallstones associated with an isolated atrophic gallbladder without a cystic duct in a 21-year-old female, emphasizing the importance of flexible surgical planning and careful postoperative management. Case description A 21-year-old female presented with a four-year history of right upper quadrant abdominal pain, intermittent jaundice, tea-coloured urine, and clay-coloured stools. Preoperative imaging suggested a Todani Type I biliary cyst with choledocholithiasis. However, intraoperative findings confirmed a Todani Type II cyst with gallstones and an atrophic gallbladder without a cystic duct. The surgical management included adhesiolysis, cholecystectomy, cyst excision, stone removal, and Roux-en-Y hepaticojejunostomy with stent placement. Results and discussion Intraoperative findings required modification of the planned Roux-en-Y procedure to ensure adequate biliary drainage. The patient showed significant clinical improvement postoperatively without complications during follow-up. Conclusion This case underscores the importance of recognizing rare biliary anomalies and adapting surgical strategies accordingly. Successful management with cyst excision and modified Roux-en-Y hepaticojejunostomy highlights the role of thorough intraoperative assessment and appropriate postoperative care. Further studies are needed to improve understanding of these uncommon conditions.