Muhammad Athar, Muhammad Hasnain Raza Haider, Mumtaz Ahmad Khan, Tanwir Khaliq, Nadeem Ahmad.
Portal Hypertension due to Choledochal Cyst.
J Coll Physicians Surg Pak Jan ;12(4):250-2.

A case of portal hypertension secondary to choledochal cyst is reported. A young female presented with haemetamesis, malena and splenomegaly in addition to the classic triad of jaundice, pain and abdominal mass. Oesophagogastroscopy revealed second degree varices. Excision of cyst and hepaticojejunostomy was performed. At six months follow up patient was completely asymptomatic with no endoscopic evidence of varices.

Case Report: BB, an 18 years old female presented in the outpatient department of Pakistan Institute of Medical Sciences with the history of yellow discoloration of sclera, high coloured urine, and a painful swelling in the right upper abdomen for three years. Recently she had an episode of haematemesis and malena. On examination she was moderately jaundiced, and febrile (101°F). A large ill-defined mass was palpable in the right upper abdomen. Spleen was enlarged four fingers below the left costal margin. Liver function tests revealed raised bilirubin (mixed pattern), raised alkaline phosphates and ALT. Ultrasound confirmed the diagnosis of choledochal cyst causing extrinsic compression of portal vein. CT scan was performed to see the extent of cyst and rule out any concomitant pathology (Figure 1 and 2). Upper gastrointestinal endoscopy was performed which showed second degree oesophageal varices with stigmata of recent bleeding. Increase in portal pressure was due to direct pressure on the portal vein and biliary cirrhosis. After thorough preparation, patient was operated; at laparotomy a large (15 x 15 cms) saccular cyst involving the supraduodenal portion of the common bile duct and common hepatic duct (Type 1a) was found pushing the duodenum and pylorus laterally and hepatic flexure of colon downward. A complete excision of cyst was followed by Roux-en-Y hepaticojejunostomy. After surgery, patient had uneventful recovery and discharged in a satisfactory condition. At six-months follow-up, she was well with normal LFTs and oesophagoscopy.

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