Martínez-Ordaz José Luis, Morales-Camacho Magdely Yazmin, Centellas-Hinojosa Sócrates, Román-Ramírez Eduardo, Romero-Hernández Teodoro, de la Fuente-Lira Mauricio
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.
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.
Cir Cir. 2016 Mar-Apr;84(2):144-53. doi: 10.1016/j.circir.2015.06.017. Epub 2015 Oct 21.
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.
To communicate the case of 3 pregnant patients with choledochal cyst.
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.
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.
胆总管囊肿较为罕见。通常在儿童期女性中出现,但在孕期也可见到。在此期间临床症状会被掩盖,从而使诊断变得复杂,并对母亲和胎儿都构成危及生命的并发症。
通报3例患有胆总管囊肿的孕妇病例。
3例孕妇被诊断为胆总管囊肿。2例出现胆管炎体征。第一例接受了肝空肠吻合术,但发生流产并于术后第10天死亡。第二例因胎儿窘迫接受了早产剖宫产手术,并在4周后接受了肝空肠吻合术;在恢复过程中发生胃穿孔,死于败血症并发症。第三例未发生胆管炎或黄疸。她孕期顺利,4周后接受了肝空肠吻合术,效果良好。
孕期胆总管囊肿的处理与胆管炎的存在有关。当对药物治疗无反应时,应进行胆道减压。明确的治疗应在孕期结束后进行。