Choledochal Cysts Aggravated during Pregnancy

Moon, Jin Soo; Kang, Hyung Kil; Lee, Bong Hwa

Abstract

The association between choledochal cysts and pregnancy is unlikely to be etiological, but may rather be an aggravation or precipitation of a preexisting condition. Although choledochal cysts rarely occur in pregnancy, the aim of this study is to elucidate the condition associated with pregnancy because delayed or inappropriate therapy may be catastrophic for both mother and child. Authors reviewed 18 cases of choledochal cyst, of which 2 were aggravated during pregnancy, managed at the Department of Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, during the period from 1990 to 1995. The results were as follows: The ratio of female to male was 2.6:1 which revealed predominance in female and most frequent age group was above sixty years old(33%). In non-pregnant patients, the most common symptoms were abdominal pain(78%) and all pregnant patients had pain, jaundice, nausea and vomiting, and indigestion. Transaminase and bilirubin were elevated in all pregnant patients. In all patients, US(88%, 100%) was the most common preoperative diagnostic study and one case was diagnosed during explo-laparotomy. Pregnant patients have cholecystitis in two cases and nonpregnant patients had cholecystitis(19%), CBD stone(19%), and others. The operative procedures were performed in 9 cases and pregnant patients were operated by cyst excision and Roux-en-Y hepaticojejunostomy in one case, and also Roux-en-Y choledochocystojejunostomy in one case. According to Todani's classification, in non pregnant patients, type I was the most common(63%), in pregnant patients, two cases were type I. Postoperative complications occurred in 3 cases, wound infection(6%) and cholangitis(6%) in non pregnant patients, pleural effusion(6%) in pregnant patients. Two cases of choledochal cyst in pregnancy were 25 years old at 29.4 weeks and 36 years old at 16 weeks into pregnancy.