One case of congenital laparoscopic choledochal cyst with postoperative chylousascites and a retrospective literature review

Abstract

Objective To report one case of congenital laparoscopic choledochal cyst with postoperative chylous ascites and review the relevant literatures of this disease for enhancing its clinician awareness. Methods One 14-day boy was hospitalized due to 4-month prenatal ultrasonic finding of hilar mass of liver with persistent jaundice.After admission, liver function examination showed that alanine aminotransferase 110 U/L, aspartate aminotransferase 180 U/L, total bilirubin 310.9 μmol/L and direct bilirubin 183.0 μmol/L.Preoperative ultrasonography, magnetic resonance cholangiopancreatography (MRCP) and intraoperative angiography revealed choledochal cyst.After preoperative examinations, laparoscopic choledochal cyst resection and Roux-Y hepaticojejunostomy were performed.The databases of PubMed, Medline, Springer Link, Cochrane Library, CNKD and Wanfang were searched for such keywords as chylous ascites, choledochal cyst and neonatal.Four cases of choledochal cyst complicated with chylous ascites were reported in both Chinese and English up until October 2018. Results Chylous ascites became resolved after 3-week conservative treatments of fasting, total parenteral nutrition and octreotide.During a 6-month follow-up period, he grew healthily without a relapse.Four cases of choledochal cyst complicated with postoperative chylous ascites were reviewed in the literature.All of them were treated conservatively.One child received only dietary treatment due to a low amount of celiac drainage (20 ml). The maximal celiac drainage was 350 ml and treatment duration lasted from 15 days to 4 weeks.All children recovered and were discharged. Conclusions Congenital laparoscopic choledochal cyst with postoperative chylous ascites is a rare disease.However, its prognosis is excellent if it is diagnosed timely and treated properly. Key words: Chylous ascites; Choledochal cyst; Infant, newborn