{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:05:20Z","timestamp":1785769520591,"version":"3.56.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Todani Type IVa choledochal cysts are rare congenital malformations involving both intrahepatic and extrahepatic bile ducts. Adult-onset, asymptomatic, and localized presentations are exceptionally uncommon and pose a surgical challenge, particularly when considering the extent of resection and reconstruction required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>We report the case of a 24-year-old asymptomatic female who was incidentally diagnosed with a localized Todani Type IVa cyst involving the left hepatic lobe and the common bile duct. Imaging revealed segmental intrahepatic cystic dilatation confined to the left lobe, with the right hepatic system remaining unaffected. The patient underwent a successful left hepatectomy and complete excision of the extrahepatic bile duct, followed by a Roux-en-Y hepaticojejunostomy directly anastomosed to the right hepatic duct. She was discharged on postoperative day 3 in excellent condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Unlike most reported cases involving diffuse or bilobar intrahepatic extension or complicated pediatric presentations, our patient had a rare, unilobar adult Type IVa cyst with no inflammatory or malignant features. The decision to perform partial hepatectomy was guided by precise preoperative imaging, allowing complete resection without the need for liver transplantation. This case highlights the role of anatomical localization and individualized surgical planning in managing select cases of Type IVa choledochal cysts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case illustrates a rare adult presentation of localized Todani Type IVa choledochal cyst, successfully treated with left hepatectomy and Roux-en-Y hepaticojejunostomy. It supports the use of tailored surgical strategies based on precise anatomical assessment, especially in asymptomatic patients with unilobar involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2025.111850","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T23:33:34Z","timestamp":1755905614000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Incidentally detected localized Todani Type IVa choledochal cyst in an asymptomatic adult female: A rare case report"],"prefix":"10.1097","volume":"135","author":[{"given":"Aows","family":"Dayoub","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Alaa","family":"Aldakak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Al-Bitar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafat","family":"Horoub","sequence":"additional","affiliation":[{"name":"Department of General Surgery of the Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"R1-47-20260803","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.hpb.2022.09.010","article-title":"Diagnosis and management of choledochal cysts","volume":"25","author":"Brown","year":"2023","journal-title":"HPB (Oxford)"},{"key":"R2-47-20260803","doi-asserted-by":"crossref","first-page":"919","DOI":"10.12688\/f1000research.123930.1","article-title":"Case report: a rare case of choledochal cyst","volume":"11","author":"Tariq","year":"2022","journal-title":"F1000Res"},{"issue":"1","key":"R3-47-20260803","first-page":"1","article-title":"Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases","volume":"108","author":"Alonso-Lej","year":"1959","journal-title":"Int. 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Sci"},{"issue":"1","key":"R8-47-20260803","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.radcr.2024.10.033","article-title":"A case of choledochal cyst type IV","volume":"20","author":"Dewi","year":"2024","journal-title":"Radiol. Case Rep"},{"issue":"1","key":"R9-47-20260803","first-page":"73","article-title":"A giant type IVA choledochal cyst","volume":"25","author":"Anand","year":"2012","journal-title":"Ann. Gastroenterol"},{"issue":"2","key":"R10-47-20260803","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1442-200X.2006.02187.x","article-title":"An unusual case of Type IV(A) choledochal cyst with subaortic ventricular septal defect","volume":"48","author":"Rayamajhi","year":"2006","journal-title":"Pediatr. Int"},{"issue":"9","key":"R11-47-20260803","article-title":"Choledochal cyst in pregnancy: a case report","volume":"14","author":"Elmasry","year":"2022","journal-title":"Cureus"},{"key":"R12-47-20260803","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijscr.2025.110898","article-title":"A large type IV-A choledochal cyst mimicking hydatid cyst of the liver: a case report","volume":"127","author":"Gemechu","year":"2025","journal-title":"Int. J. Surg. 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