DOI: http://dx.doi.org/10.18203/2349-2902.isj20214391

The role in the decision-making of the surgeon in choledochal cysts during pregnancy

Carlos F. Nicolás-Cruz, Paola I. Pech-Cervantes, Juan A. Loyo-Cosme, Omar M. Herrera-Ortiz de Ora, Jorge A. Ordoñez-García, Fabiola Valdez-Maldonado, Jose Manuel Degante-Aguilar

Abstract


The diagnosis and management of bile duct diseases during pregnancy are highly controversial because preserving both the fetus and pregnancy often required surgical intervention. In this manuscript we reported three cases of pregnant patients referred to our hospital with choledochal cyst. Medical management was implemented until fetal well-being was compromise with moderate cholangitis and oligohydramnios. A C-section prior induction with lung ripeness was performed, four weeks later cyst resection and biliodigestive derivation was performed prior preoperative parenteral total nutrition was implemented. All patients and products survived without complications.  


Keywords


Choledochal cyst, Pregnancy, Hepp couinaud biliary-digestive derivation

Full Text:

PDF

References


Singham J, Schaeffer D, Yoshida E, Scudamore C. Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients. HPB (Oxford). 2007;9(5):383‐7.

Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile ducts cysts: Classification, operative procedures and review of thirty seven cases including cancer arising from choledocal cysts. Am J Surg. 1977;134:236-9.

Ingham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg. 2009;52(5):434‐40.

Alonso-LEJ F, Rever WB, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg. 1959;108:1-30.

Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 2 of 3: Diagnosis. Can J Surg. 2009;52:506-11.

Jia B, Tan L, Jin Z, Liu Y. Duel-stage treatment for biliary cysts with cholangitis during pregnancy. Pak J Med Sci. 2017;33(2):483‐87.

Ronnekleiv-Kelly SM, Soares KC, Ejaz A, Pawlik TM. Management of choledochal cysts. Curr Opin Gastroenterol. 2016;32(3):225‐31.

Saluja SS, Nayeem M, Sharma BC, Bora G, Mishra PK. Management of choledochal cysts and their complications. Am Surg. 2012;78(3):284‐90.

Vatero A. Dissertation in Auguralis Medica Proes. Diss qua scirrhris viscerum disseret c.s. exlerus. (University Library, Edinburg). 1723;70:19.

Douglas AH. Case of Dilatation of the Common Bile Duct. Monthly J Med Sc (London). 1852;14:97.

Cha SW, Park MS, Kim KW, Byun JH, Yu JS, Kim MJ, et al. Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications. J Comput Assist Tomogr. 2008;32(5):827.

Varun N, Elahi AA, Gupta N. Ruptured choledochal cyst during early pregnancy with successful fetomaternal outcome Case Reports. 2018;2018:bcr-2018-224357.

Mackillop L, Williamson C. Liver disease in pregnancy. Postgrad Med J. 2010;86(1013):160-4.

Basso L, McCollum PT, Darling MRN. A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis. Surg Gynecol Obstet. 1992;175:41.

Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120-33.

Singh H, Gupta R, Dhaliwal L, Singh R. Spontaneous choledochal cyst perforation in pregnancy with co-existent chronic pancreatitis. BMJ Case Rep. 2014;2014:bcr2014207183.

Conway WC, Campos GM, Gagandeep S. Choledochal cyst during pregnancy: the patient's first pregnancy was complicated by a congenital anomaly. Am J Obstet Gynecol. 2009;200(5):588.e1-2.

Nasu K, Matsuki S, Kawano Y, Miyakawa I, Nakashima K, Anai H. Choledochal cyst diagnosed and conservatively treated during pregnancy. Am J Perinatol. 2004;21(8):463-8.

Koh KS, Bickle I, Mathew VV, Chong VH. Choledochal cyst in pregnancy. Malays Fam Physician. 2016;11(2-3):27-9.

Kitahama A, Harkness SO, Moynihan PO, Webb WR. A large choledochal cyst with impending rupture post partum. Br J Surg. 1984;71:156.

Varun N, Elahi AA, Gupta N, Nigam A. Ruptured choledochal cyst during early pregnancy with successful fetomaternal outcome. BMJ Case Rep. 2018;2018:bcr2018224357.

Morales-Maza J, Rodríguez-Quintero JH, Cortés-Vázquez S. Giant choledochal cyst presenting during third trimester of pregnancy Case Reports. 2018;2018:bcr-2018-224891.

Jabłońska B. Biliary cysts: etiology, diagnosis and management. World J Gastroenterol. 2012;18(35):4801‐10.