Dayoub Aows, Aldakak Mohammad Alaa, Al-Bitar Ahmad, Horoub Rafat
Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Department of General Surgery of the Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Int J Surg Case Rep. 2025 Oct;135:111850. doi: 10.1016/j.ijscr.2025.111850. Epub 2025 Aug 22.
Todani Type IVa choledochal cysts are rare congenital malformations involving both intrahepatic and extrahepatic bile ducts. Adult-onset, asymptomatic, and localized presentations are exceptionally uncommon and pose a surgical challenge, particularly when considering the extent of resection and reconstruction required.
We report the case of a 24-year-old asymptomatic female who was incidentally diagnosed with a localized Todani Type IVa cyst involving the left hepatic lobe and the common bile duct. Imaging revealed segmental intrahepatic cystic dilatation confined to the left lobe, with the right hepatic system remaining unaffected. The patient underwent a successful left hepatectomy and complete excision of the extrahepatic bile duct, followed by a Roux-en-Y hepaticojejunostomy directly anastomosed to the right hepatic duct. She was discharged on postoperative day 3 in excellent condition.
Unlike most reported cases involving diffuse or bilobar intrahepatic extension or complicated pediatric presentations, our patient had a rare, unilobar adult Type IVa cyst with no inflammatory or malignant features. The decision to perform partial hepatectomy was guided by precise preoperative imaging, allowing complete resection without the need for liver transplantation. This case highlights the role of anatomical localization and individualized surgical planning in managing select cases of Type IVa choledochal cysts.
This case illustrates a rare adult presentation of localized Todani Type IVa choledochal cyst, successfully treated with left hepatectomy and Roux-en-Y hepaticojejunostomy. It supports the use of tailored surgical strategies based on precise anatomical assessment, especially in asymptomatic patients with unilobar involvement.
托达尼IVa型胆总管囊肿是一种罕见的先天性畸形，累及肝内和肝外胆管。成人发病、无症状且局限的表现极为罕见，给手术带来挑战，尤其是在考虑所需的切除范围和重建时。
我们报告一例24岁无症状女性病例，该患者偶然被诊断为局限于左肝叶和胆总管的托达尼IVa型囊肿。影像学检查显示肝内节段性囊性扩张局限于左叶，右肝系统未受影响。患者成功接受了左肝切除术和肝外胆管完全切除术，随后进行了直接与右肝管吻合的Roux-en-Y肝空肠吻合术。她于术后第3天出院，状况良好。
与大多数报道的涉及弥漫性或双叶肝内扩展或复杂儿科表现的病例不同，我们的患者患有罕见的单叶成人IVa型囊肿，无炎症或恶性特征。部分肝切除术的决定基于精确的术前影像学检查，无需肝移植即可实现完全切除。该病例突出了解剖定位和个体化手术规划在处理特定IVa型胆总管囊肿病例中的作用。
本病例说明了托达尼IVa型胆总管囊肿罕见的成人局限性表现，通过左肝切除术和Roux-en-Y肝空肠吻合术成功治疗。它支持基于精确解剖评估采用定制的手术策略，特别是在单叶受累的无症状患者中。
