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.