Biliary tract anomalies: the utilization of modern techniques in differential diagnosis

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Congenital biliary tract anomalies in infants, including choledochal cysts, biliary atresia, and biliary stenosis, present diagnostic challenges.
• Clinical presentations in infants with biliary atresia or stenosis often mimic the obstructive phase of neonatal hepatitis, complicating differentiation.

Purpose of the Study:

• To evaluate the efficacy of diagnostic aids, adapted from adult biliary disease protocols, for identifying congenital biliary tract anomalies in infants.
• To determine reliable methods for distinguishing between choledochal cysts, biliary atresia, biliary stenosis, and neonatal hepatitis in the pediatric population.

Main Methods:

• Intravenous cholecystography was employed to differentiate choledochal cysts from other upper abdominal masses.
• Serial total serum bilirubin curves, fecal and urinary pigment analysis, and duodenal intubation for bilirubin determination were utilized for differentiation.
• Operative cholangiograms and intraoperative frozen section liver biopsies were assessed for their diagnostic utility.

Main Results:

• Intravenous cholecystography effectively distinguished choledochal cysts.
• Serial bilirubin curves, stool/urine pigment analysis, and duodenal intubation proved valuable in differentiating biliary atresia/stenosis from neonatal hepatitis.
• Operative cholangiograms were helpful in select cases, while frozen section liver biopsies offered limited diagnostic value except for rare intrahepatic biliary atresia.

Conclusions:

• A combination of clinical assessment, serial bilirubin monitoring, pigment analysis, and duodenal intubation is crucial for diagnosing congenital biliary tract anomalies in infants.
• Standard liver function tests, including transaminase levels, were not found to be helpful in differentiating these conditions in infants.