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MR cholangiopancreatography findings in children with spontaneous bile duct perforation
Mi-Jung Lee1, Myung-Joon Kim, Choon-Sik Yoon
1Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemungu, Seoul, 120-752, Korea.
Insights
Spontaneous bile duct perforation (SBP) in children is rare but treatable with surgery. Magnetic resonance cholangiopancreatography (MRCP) effectively identifies fluid collections and bile duct anomalies associated with SBP.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Spontaneous bile duct perforation (SBP) is an uncommon pediatric surgical emergency.
- Prompt diagnosis of SBP is crucial for timely surgical intervention and improved outcomes.
Observation:
- This study evaluated three pediatric cases of SBP confirmed surgically.
- Patients underwent ultrasound (US), MRCP, and hepatobiliary scintigraphy prior to surgery.
Findings:
- MRCP revealed loculated fluid collections at the porta hepatis and associated bile duct anomalies, including low cystic duct insertion and choledochal cysts.
- US identified ascites in all cases, while hepatobiliary scintigraphy confirmed bile leaks.
Implications:
- MRCP is a valuable tool for diagnosing SBP in children by visualizing periprforation fluid collections.
- Findings highlight the utility of MRCP in identifying relevant biliary anatomy and anomalies in pediatric SBP cases.
Background:
Spontaneous bile duct perforation (SBP) is rare in children. Early diagnosis is important because the condition can be treated surgically.
Objective:
The purpose of this study is to report MR cholangiopancreatography (MRCP) findings of SBP and to evaluate the usefulness of MRCP.
Materials And Methods:
Over the last 10 years, three children (1 boy, 2 girls; ages 3, 4 and 15 months) underwent US, MRCP and hepatobiliary scintigraphy preoperatively and were surgically confirmed to have extrahepatic bile duct perforation.
Results:
US showed ascites in all children and a choledochal cyst in one. On MRCP, a moderate-to-large volume of ascites was seen in addition to a loculated fluid collection at the porta hepatis. MRCP also depicted the low insertion of the cystic duct and choledochal cyst in each case. Hepatobiliary scintigraphy showed bile leak from the region of the porta hepatis extending to the whole abdomen. According to the surgical findings, the perforation site was around the junction of the cystic duct and the common hepatic duct in all children.
Conclusion:
In children with SBP, MRCP can depict the loculated fluid collection adjacent to the perforation site and associated bile duct anomalies.
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