Choledochal cysts are uncommon dilatations of the biliary tree. Giant choledochal cysts are those that exceed a maximum diameter of 10cm. Our case describes a female infant who presented to our paediatric surgery department with a three-day history of vomiting, abdominal distention, pale stool, and irritability. On palpation, she was found to have a large abdominal mass and the computed tomography (CT) scan showed a giant choledochal cyst. The patient underwent laparotomy with cholecystectomy, choledochal cyst drainage and complete excision, with hepaticojejunosotomy. At the last follow-up three years post-surgery, all growth parameters and liver enzymes were within normal ranges. To the best of our knowledge, this is the first documented case of a giant choledochal cyst in the paediatric Caribbean population.

BACKGROUND: Aim is to evaluate geographical and demographic factors influencing management of bile duct injuries occurring during cholecystectomy in a tertiary hepato-pancreato-biliary center in Southeast US.
METHODS: All referrals for biliary injuries during cholecystectomy, between Jan 2017 and December 2020 were included.
RESULTS: 19 patients were identified with a median age of 59 (47-65), average BMI of 30.3 (18-49), and the prevalence of diabetes mellitus, hypertension and cardiovascular disease of 11%, 47% and 16%, respectively. The average transfer distance was 76 miles (8-102) and median transfer time was 3 days (1-12). 16 (84%) had Strasberg E injury, with 4 (21%) having a concomitant vascular injury (3 - right hepatic artery, 1 - right portal vein). Two (10.5%) were managed non-operatively, immediate surgical repair was performed in 2 (10.5%) and 15 (78.9%) patients underwent a delayed repair with a median of 87 days (69-118) from injury to repair. Median operative time was 5 hours (4-7), blood loss was 150 mL (100-200) and hospital stay was 8 days (6-12).
CONCLUSIONS: Factors including distance between hospitals, delays in patient transfer due to bed availability and transportation, play a role in the decision-making towards delayed repair. The delayed repair has the benefit of medical optimization of our high-risk patients\' population.