Giant choledochal cyst presenting during third trimester of pregnancy

Abstract

Biliary cystic disease is a rare entity. Twenty-five per cent of cases are diagnosed during adulthood and only a few reports have described this condition during pregnancy, where it represents a therapeutic challenge for both obstetricians and surgeons with regard to the risks it entails for the patient and the fetus.Definitive management is surgical resection, as cysts may progress to malignancy if untreated. During pregnancy, resection is generally deferred to after delivery, especially in the context of suspected cholangitis.A 19-year-old young woman with no previous prenatal control, presented to the emergency department on her 32nd week of gestation with abdominal pain and jaundice. A giant Todani I biliary cyst was observed on imaging along with dilation of the proximal biliary tree suggesting acute cholangitis. Fetal compromise prompted immediate delivery after which percutaneous biliary drainage was performed. Following recovery, the cyst was surgically resected.

Successful Antenatal Diagnosis and Management of a Rare Case of Congenital Fetal Choledochal Cyst

“…The prenatal ultrasound patterns make an antenatal differential diagnosis of biliary anomalies. 5 A study shown significantly lower amniotic fluid gamma-glutamyl transferase values in fetus with choledochal cyst, indicate decreased bile excretion in utero. 6 The three-dimensional USG using new, multislice view technique, display serial images at variable intervals (0.5-5 mm) similar to MRI or computed tomography.…”

“…A neonate when delivered with prenatal diagnosis of choledochal cyst should be evaluated to rule out biliary atresia. The prenatal ultrasound patterns make an antenatal differential diagnosis of biliary anomalies 5 . A study shown significantly lower amniotic fluid gamma-glutamyl transferase values in fetus with choledochal cyst, indicate decreased bile excretion in utero 6 .…”

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

“…[19][20][21] The definitive treatment of the cyst is necessary for cases treated conservatively during pregnancy; the ideal surgical procedure considered in world literature is complete cyst excision with cholecystectomy followed by biliary reconstruction using a Roux-en-Y hepatic-jejunostomy as the treatment of choice. 22 The di-lemma is still how and when. 23 In this article, according to our experience, we propose it to be four weeks after the resolution of the pregnancy to give more time of effect to pre-operative parenteral nutrition and to be close to the end of the puerperium.…”

Choledochal Cyst in Pregnancy: A Case Report

“…Choledochal cyst is a rare congenital malformation of the biliary tree [ 1 ]. It can appear in various locations along the biliary tree depending on the type, which was first described in 1959 by Alonso-lej et al, who classified it into three types of duct dilation [ 2 ].…”