Therapeutic intervention:
Laparotomy through an extended midline incision was done. A gross
enlarged cystic mass extending from the liver up to the hypo-gastric
region with the duodenum, the gall bladder, greater omentum and
transverse colon adherent onto the cystic mass (Figure 4). Adhesions
were careful divided, separating the duodenum, transverse colon from the
cystic mass, and achieved hemostasis. Dissection continued medially and
laterally to release the attachments of the cyst from other
intra-abdominal wall structures. The mass was approximately 30cmx 25cmx
20cm containing around 3 liters of greenish, bilious fluid (Figure 5 &
6). Cystic duct was identified and anterograde cholecystectomy was
performed. A loop of jejunum 45cm from the ligament of treitz was
brought near the stump of common hepatic duct through a defect created
on the left side of the middle colic vessels in the transverse
mesocolon. Hepaticojejunostomy and jejunojejunostomy was done using
Braun procedure (Figure 7). A drain was left in proximity to the site of
biliary reconstruction and was removed 6 days later after spending 3
days without any collection in its bag. The specimen was sent for
histo-pathological examination and was reported to contain chronic
inflammatory infiltrate with no evidence of malignancy and the patient
recovered.