PRENATAL-DIAGNOSIS OF A CHOLEDOCHAL CYST - A CASE-REPORT AND REVIEW OF THE LITERATURE

There are 16 reported cases of prenatally diagnosed choledochal cyst i n the literature. We present a new case diagnosed at 29 weeks' gestati on by routine ultrasound scanning. At 40 weeks' gestation, a male infa nt was born by spontaneous delivery. At 16 weeks of age, the patient u nderwent a laparotomy, which confirmed the diagnosis of a choledochal cyst. The cyst and the gallbladder were removed en bloc and reconstruc tion of the biliary tree was performed by formation of a retrocolic Ro ux-en-Y hepatojejunostomy with an antireflux valve. Histological exami nation of the cyst showed a thickened fibrous tissue wall with necroti sing areas and without epithelial lining. The patient's postoperative course was uneventful. Review of the literature shows that it is possi ble to make a presumptive prenatal diagnosis of this anomaly as early as 15 weeks' gestation. The differential diagnosis of a sonolucent les ion in the fetus should also include the rare choledochal cyst. Treatm ent of choice is the radical excision of the cyst with construction of a Roux-en-Y hepaticoenterostomy. Long-term results with this method a re very good. Surgery may be instituted at the earliest possible oppor tunity before severe complications such as cholangitis, liver abscesse s, cirrhosis, and malignant degeneration can occur.