Clinical Practice and Cases in Emergency Medicine

Introduction: Choledochal cysts are rare congenital dilatations of the biliary tree that may present with nonspecific gastrointestinal symptoms in children, posing diagnostic challenges. 

Case Report: We report a 3-year-old girl who presented with recurrent vomiting and abdominal pain. Initial laboratory testing revealed a mildly elevated lipase. An abdominal ultrasound demonstrated a pancreatic cyst; the patient was discharged with outpatient follow-up. She returned with worsening symptoms and a markedly elevated lipase of 2,247 U/L (reference range, < 160 U/L). Computed tomography subsequently revealed a type I choledochal cyst. She underwent operative resection with an uncomplicated postoperative course.

Conclusion: Persistent gastrointestinal symptoms with uptrending lipase in children should prompt consideration of hepatobiliary etiologies. Choledochal cysts may be missed on initial presentation as the classic triad of jaundice, palpable abdominal mass, and right upper quadrant pain is present in a minority of cases.