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Pakkala AK, Nekarakanti PK, Nagari B, Bansal AK, Thumma V, Gunturi SV. An audit of Complicated Choledochal Cysts- 15-years' experience at a tertiary care center. Langenbecks Arch Surg 2023; 408:212. [PMID: 37247085 DOI: 10.1007/s00423-023-02952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Complicated choledochal cysts (CDC) have a variable presentation, and their management differs from an uncomplicated CDC. They are infrequently reported. We present our 15 years of experience in the management of complicated CDC. METHODOLOGY We reviewed the data of patients with CDCs managed at a tertiary level center from 2005 to 2020 from a prospectively maintained database. RESULTS Of 215 patients with CDC, 123 patients presented with complicated CDC. The median age of complicated CDC was 31 years with a female preponderance (62.6%). The most common type of CDC associated with complications was type I (69.1%), followed by type IVA (29.3%). The Complicated CDC was presented as cholangitis with or without cystolithiasis (n = 45), cystolithiasis and hepatolithiasis(n = 44), malignancy(n = 10), complications associated with incomplete cyst excision (n = 10), acute pancreatitis (n = 8), chronic pancreatitis(n = 8), portal hypertension (n = 6), spontaneous rupture (n = 4), gastric outlet obstruction (n = 1). These patients were managed as a one-stage approach (52.03%) and a two-stage approach (47.96%). On univariate and multivariate analysis, increasing age, prolonged duration of symptoms, and presence of abnormal pancreaticobiliary ductal junction (APBDJ) were significantly associated with complicated CDC. CONCLUSION The management of complicated CDC varied depending on the associated pathology, many of them required a staged approach. Increasing age, prolonged duration of symptoms, and presence of APBDJ were significantly associated with complicated CDC.
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Affiliation(s)
- Amith Kumar Pakkala
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Phani Kumar Nekarakanti
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Bheerappa Nagari
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India.
| | - Ashish Kumar Bansal
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - VenuMadhav Thumma
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
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Elmasry AI, Ali SM, Neama DA, Marzooq AM. Choledochal Cyst in Pregnancy: A Case Report. Cureus 2022; 14:e29774. [PMID: 36340554 PMCID: PMC9618035 DOI: 10.7759/cureus.29774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Choledochal cyst is a rare congenital malformation of the biliary tree. It can be present in various locations along the biliary tree. The diagnosis of choledochal cyst during pregnancy can be challenging for clinicians due to its atypical presentation. In this case report, we discuss a case of a female patient who presented in the third trimester. She was misdiagnosed with cholecystitis and was treated medically. She underwent emergency lower segment cesarean section (LSCS) and was then discharged. The patient later presented with the same symptoms and was diagnosed with choledochal cyst type IVA. She underwent percutaneous drainage and improved. The patient had to deliver the baby prematurely due to the late diagnosis and thus late treatment. In order to avoid the recurrence of those events, physicians should be familiar with the presentation of a choledochal cyst and should subsequently use the proper imaging modalities such as MRI more frequently in pregnant patients with such presentation, which will result in an early diagnosis and prevent the maternal and fetal complications.
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Jia B, Tan L, Jin Z, Liu Y. Duel-stage treatment for biliary cysts with cholangitis during pregnancy. Pak J Med Sci 2017; 33:483-487. [PMID: 28523061 PMCID: PMC5432728 DOI: 10.12669/pjms.332.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background & Objective: Biliary cysts in pregnant women are a complex medical issue, especially when complicated with cholangitis. It is a serious and life-threatening diagnosis that can seriously endanger both the expectant mother and the fetus. However, during pregnancy, surgical treatment would lead to further complications and higher fetal mortality. Here, we propose a novel therapeutic approach that would be safe for both mother and child during pregnancy, with a definitive treatment postponed until after delivery. Methods: In this retrospective study we have summarized the clinical course of six adult patients diagnosed with choledochal cysts during pregnancy. Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst excision when the patients recovered from delivery. Results: All the six patients gave birth to healthy babies. Four patients had Type-I choledochal cysts, and underwent Roux-en-Y hepaticojejunostomy surgery. Two patients had a Type-IV choledochal cyst. The first patient with Type-IV choledochal cyst underwent anastomosis between the secondary hepatic bile duct and jejunum and the second patient underwent laparoscopic cyst internal drainage. No serious complications were recorded after gallbladder drainage or during the perioperative period. Conclusions: Based on our single-centre experience we can conclude that treatment of choledochal cyst with cholangitis during pregnancy can be conducted safely and efficiently through the two stages strategy that we proposed in this paper. The first stage should be percutaneous cholecystostomy followed by elective surgical treatment following delivery.
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Affiliation(s)
- Baoxing Jia
- Baoxing Jia, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ludong Tan
- Ludong Tan, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhe Jin
- Zhe Jin, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Yahui Liu, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
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Martínez-Ordaz JL, Morales-Camacho MY, Centellas-Hinojosa S, Román-Ramírez E, Romero-Hernández T, de la Fuente-Lira M. [Choledochal cyst during pregnancy. Report of 3 cases and a literature review]. CIR CIR 2015; 84:144-53. [PMID: 26477375 DOI: 10.1016/j.circir.2015.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Choledochal cysts are rare. They usually present during childhood in women, but it can also be seen during pregnancy. Clinical signs and symptoms are obscured during this time, thus it can complicate the diagnosis and represent a life threatening complication for both the mother and the child. OBJECTIVE To communicate the case of 3 pregnant patients with choledochal cyst. CLINICAL CASES Three pregnant women in which choledochal cyst were diagnosed. Two developed signs of cholangitis. The first one underwent a hepatic-jejunostomy, but had an abortion and died on postoperative day 10. The second one had a preterm caesarean operation due to foetal distress and underwent a hepatic-jejunostomy 4 weeks later; during her recovery she had a gastric perforation and died of septic complications. The third one did not develop cholangitis or jaundice. She had an uneventful pregnancy and had a hepatic-jejunostomy 4 weeks later with good results. CONCLUSIONS Management of choledochal cysts during pregnancy is related to the presence of cholangitis. When they do not respond to medical treatment, decompression of the biliary tree is indicated. Definitive treatment should be performed after resolution of the pregnancy.
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Affiliation(s)
- José Luis Martínez-Ordaz
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México.
| | - Magdely Yazmin Morales-Camacho
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Sócrates Centellas-Hinojosa
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Eduardo Román-Ramírez
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Teodoro Romero-Hernández
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México
| | - Mauricio de la Fuente-Lira
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social, Instituto Mexicano del Seguro Social, México, D.F., México
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Sallahu F, Hasani A, Limani D, Shabani S, Beka F, Zatriqi S, Murati S, Jashari H. Choledochal cyst - presentation and treatment in an adult. Acta Inform Med 2013; 21:138-9. [PMID: 24058256 PMCID: PMC3766534 DOI: 10.5455/aim.2013.21.138-139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/28/2013] [Indexed: 12/18/2022] Open
Abstract
CONFLICT OF INTEREST NONE DECLARED Choledochal cyst is a congenital cystic dilation of a part of bile duct that occurs most commonly in the main part of common bile duct. Diagnosis of choledochal cyst is concluded upon disproportionate expansion of extrahepatic bile duct. Symptom trias are: abdominal pain, jaundice and abdominal mass represent clinical guideline signs of diagnosis. Furthermore, hepato-biliary diseases in adults can conceal the primary condition. In addition to this, ultrasound, CT, MRI, cholangiopancreatography (ERCP), transhepatic percutane cholangiography (PTC) guide us for a detailed examination in order to verify the diagnosis. Active endoscopic cholangiography represents an important technique that provides needed anatomic solution and details in diagnosis of choledochal cyst.
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Affiliation(s)
- Ferat Sallahu
- Clinic of Surgery, University Clinical Centre of Kosovo , Prishtina, Kosovo
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Furuhashi S, Takamori H, Nakahara O, Ikuta Y, Tanaka H, Horino K, Baba H. Choledochal cyst during pregnancy: case report and literature review of treatment. Clin J Gastroenterol 2013; 6:326-8. [PMID: 26181738 DOI: 10.1007/s12328-013-0389-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 05/15/2013] [Indexed: 11/24/2022]
Abstract
Choledochal cysts are uncommon conditions, usually diagnosed during childhood, but rarely during pregnancy. Choledochal cysts during pregnancy carry several risks, including development of biliary tract cancer and peritonitis due to rupture of dilated cysts induced by pregnancy itself. We present here a case of choledochal cyst during pregnancy, and discuss appropriate treatments for choledochal cysts first presenting during pregnancy. A 25-year-old primigravida at 15 weeks' gestation was admitted to our hospital with abdominal pain. Magnetic resonance cholangiopancreatography diagnosed a type 1 choledochal cyst without a mass lesion. A healthy baby arrived without complication at 38 weeks' gestation. The patient underwent cholecystectomy and choledochal cyst excision. The postoperative course was uneventful with discharge on day 8. Pathological examination diagnosed no malignant feature. Surgery may be performed after delivery for choledochal cysts first presenting during pregnancy, and monitoring with magnetic resonance imaging, blood tests, and ultrasonography is necessary during observation.
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Affiliation(s)
- Satoshi Furuhashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Takamori
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Osamu Nakahara
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshiaki Ikuta
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kei Horino
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Spontaneous choledochal cyst rupture in pregnancy with concomitant chronic pancreatitis. Indian J Gastroenterol 2013; 32:127-9. [PMID: 23238690 DOI: 10.1007/s12664-012-0286-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 11/14/2012] [Indexed: 02/04/2023]
Abstract
Choledochal cysts are rare cystic transformations of the biliary tree that are increasingly diagnosed in adult patients. We report here a case of spontaneous rupture of a choledochal cyst in a pregnant young lady with chronic pancreatitis.
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Singham J, Yoshida EM, Scudamore CH. Choledochal cysts. Part 3 of 3: management. Can J Surg 2010; 53:51-56. [PMID: 20100414 PMCID: PMC2810009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2008] [Indexed: 05/28/2023] Open
Abstract
Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.
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Affiliation(s)
| | | | - Charles H. Scudamore
- Correspondence to: Dr. C.H. Scudamore, Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health, Care Centre, 2775 Laurel St., Floor 5, Vancouver BC V5Z 1M9, fax 604 875-5869,
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Hasiakos D, Papakonstantinou K, Vaggos G, Vitoratos N, Papadias K. Full-term pregnancies after multiple hepatobiliary operations for choledochal cyst: A case report. J Obstet Gynaecol Res 2009; 35:169-72. [DOI: 10.1111/j.1447-0756.2008.00840.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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