Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
J Nippon Med Sch. 2024;91(4):417-421. doi: 10.1272/jnms.JNMS.2024_91-401.
We report a rare case of choledochal cyst with acute cholangitis that was diagnosed at 37 weeks' gestation and treated by laparoscopic choledochal resection and biliary reconstruction after delivery. A 31-year-old Japanese primigravida at 37 weeks' gestation presented with right upper quadrant pain. The patient was diagnosed as having acute cholangitis due to a type-Ia choledochal cyst, according to the Todani classification, with pancreaticobiliary maljunction. Acute cholangitis improved with conservative treatment, the fetus was delivered by Cesarean section at 38 weeks' gestation, and the patient was treated by laparoscopic choledochal cyst excision and biliary reconstruction at 47 days postpartum. Total operation time was 579 minutes and intraoperative body fluid loss was 100 mL. The patient is now healthy with normal liver function 7 years after the operation. To ensure good outcomes for the mother and fetus, treatment decisions for choledochal cyst diagnosed during pregnancy must be carefully considered.
我们报告了一例罕见的妊娠 37 周时诊断为胆总管囊肿伴急性胆管炎的病例,并在分娩后通过腹腔镜胆总管切除和胆道重建进行治疗。一位 31 岁的初产妇在妊娠 37 周时出现右上腹疼痛。根据 Todani 分类,该患者被诊断为具有胰胆管合流异常的Ⅰa 型胆总管囊肿所致的急性胆管炎。通过保守治疗,急性胆管炎得到改善,胎儿在妊娠 38 周时通过剖宫产分娩,患者在产后 47 天行腹腔镜胆总管囊肿切除和胆道重建。总手术时间为 579 分钟,术中失血量为 100 毫升。术后 7 年,患者肝功能正常,身体健康。为了确保母婴的良好结局,必须仔细考虑对妊娠期间诊断出的胆总管囊肿的治疗决策。