Choledochal cysts in pregnancy: Case management and literature review

Table 1 diagnostic and therapeutic challenge to a broad

Patients		Type	Size (cm)	Chief Complaints	Treatment		Complication		Survival time (postoperation)	Prognosis (postoperation)
No.	Age(yr)				Initial operation	Final operation	Early	Late
1	27	IV	12 × 9 × 10	Abdominal pain Jaundice Abdominal mass	Roux-en-Y cystojejunostomy with T-tube external drainage		Septic shock and multi-organ failure		25 d	died
2	23	IV	15 × 16 × 3	Abdominal pain Jaundice	Plasement and fixation of a catheterization	Roux-en-Y cystojejunostomy			15 yr	survived
3	26	I	20 × 20 × 20	Jaundice Abdominal mass	Roux-en-Y cystojejunostomy	Exploratory biopsy	Retrograde cholangitis	Intermittent recurrence of Retrograde cholangitis Cholangioadenocarcinoma	10 yr	died

Table 2 Analysis of pre-operation laboratory values for 3 patients

Parameters	Normal range	Patient No. 1	Patient No. 2	Patient No. 3
Total bilirubin (μmol/L)	1.6-20.6	59	57	26
Direct bilirubin (μmol/L)	0-6.4	8.0	8.7	8.1
Alkaline phosphatase (U/L)	35-150	171	63	110
r-GT (U/L)	0-60	51	58	26
Aspartate aminotranferase (U/L)	0-40	37	37	37
Alanine aminotranferase (U/L)	0-40	5	11	102
Total protein (g/L)	60-85	40	67	55
Albumin (g/L)	35-55	18	39	32
Globin (g/L)	-	22	25	23
Potassium (mmol/L)	3.5-5.5	1.9	4.2	4
Sodium (mmol/L)	135-145	134	128	139
Chloride (mmol/L)	101-111	89.3	96.9	105
Hemoglobin (g/L)	120-160	74	150	122
Erythrocyte (1012/L)	3.5-5.5	2.4	4.81	3.9
Hemoleukocyte (109/L)	3.5-10	5.8	4.4	9.7
Platelet (109/L)	100-300	92	177	128

Table 3 Todani modification of the Alonso-Lej, classification system of choledochal cyst

Type I	Fusiform dilation of the extrahepatic bile duct
Type II	Single saccular dilation or diverticulum of the extrahepatic bile duct
Type III	Dilation of the intraduodenal portion of the bile duct
Type IVa	Combined intra-and extrahepatic dilation of the bile duct
Type IVb	Multiple dilations of the extrahepatic bile duct
Type V	Isolated or diffuse intrahepatic biliary dilation (Caroli’s disease when associated with hepatic fibrosis)