Type IV-A choledochal cysts during pregnancy

Abstract

Purpose: Choledochal cysts in pregnant women represent a diagnostic and therapeutic challenge to a broad spectrum of the medical profession. As a result, diagnosis is often delayed until patients present with life-threatening complications. We reported our experiences in managing one case of choledochal cyst in pregnant patient Case report: A 28-year-old primigravida at 36-wk gestation presented with jaundice, upper abdominal pain during the past three months and was admitted. Ultrasound & MRI examination showed a cystic lesion, 12 cm × 9 cm × 10 cm at the right upper quadrant with a dilated intrahepatic ducts in left lobes of liver. Diagnosis was gestation with a type IV-A choledochal cyst. Percutaneous transhepatic biliary drainage was performed. She delivered C/S 2 weeks later. As choledochal cyst was attached to the surrounding tissues, it was dissected using Left lobectomy & cyst Excision and hepaticojejunostomy 3 weeks after delivery. The patient was discharged 10 d postoperation. Conclusion: More conservative approaches such as external drainage of choledochal cyst should be considered for pregnant patients with high risk, complete excision of choledochal cyst during hepaticojejunostomy is recommended at the optimal time. Excision of only the extrahepatic part of the cyst has become the accepted form of treatment for type-IV-A cysts. Hepatic resection for a type IV-A choledochal cyst should be considered when the intrahepatic dilatation is confined to one part of the liver We think that lt. lobectomy may be indicated in type IV-A choledochal cyst pts. with an intrahepatic stricture that exist deep in the liver parenchyma.