Ruptured choledochal cyst: One-stage or two-stage, open or laparoscopic surgery?

Choledochal cyst (CDC) can present with complications such as cholangitis, perforation, pancreatitis and malignancy. Compared to the open technique for CDC, advantages of laparoscopic surgery are well known. Biliary peritonitis secondary to perforation/rupture of CDC is rare and is described in <2% of cases. In ruptured CDC, there are different approaches of management like peritioneal lavage, and biliary drainage by T-tube or Cholecystosomy/choledochostomy or endoscopic retrograde cholangiopancreatography stenting and definitive repair after 4-6 weeks as two-staged procedure. Laparoscopy is a procedure of technical challenge and complexity in ruptured CDC. We discuss here our experience of single-stage laparoscopic excision and biliary reconstruction in ruptured CDC. Child was stabilised by percutaneous drain and one-stage laparoscopic reconstruction was done on day 4, reducing the burden/morbidity of carrying biliary drain, length of stay and cost factor. To the best of our knowledge one-stage laparoscopy in ruptured CDC has not been reported earlier.