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Choledochal cyst and biliary atresia in the neonate: imaging findings in five cases
J M Torrisi1, J O Haller, F T Velcek
1Department of Radiology, SUNY Health Science Center, Brooklyn 11203.
Insights
This study highlights that early detection of choledochal cysts with extra-hepatic biliary atresia in neonates is crucial. Combined ultrasound and scintigraphy aid in prompt diagnosis and surgical treatment, preventing complications.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Neonatal Jaundice
Background:
- Choledochal cysts associated with extra-hepatic biliary atresia are rare in neonates.
- Neonatal jaundice and acholic stools are key presenting symptoms.
Purpose of the Study:
- To describe the radiologic findings in neonates with choledochal cyst and extra-hepatic biliary atresia.
- To emphasize the importance of early diagnosis for preventing biliary obstruction complications.
Main Methods:
- Retrospective review of five neonates diagnosed with choledochal cyst and extra-hepatic biliary atresia.
- Utilized sonography and hepatobiliary scintigraphy for preoperative diagnosis.
- Surgical findings and intraoperative cholangiography confirmed diagnoses.
Main Results:
- Sonography identified a separate cystic structure (choledochal cyst) in four patients.
- Hepatobiliary scintigraphy accurately diagnosed distal common bile duct atresia preoperatively.
- All five patients underwent successful surgical treatment within one month of diagnosis.
Conclusions:
- Early detection of this rare neonatal condition is vital.
- Combined sonography and hepatobiliary scintigraphy are effective diagnostic tools.
- Prompt surgical management prevents severe complications of biliary obstruction.
Abstract:
The radiologic findings in five neonates with choledochal cyst associated with extra-hepatic biliary atresia are described. All five patients (age range, 13-72 days) presented with jaundice and acholic stools. In all four patients who underwent sonographic examination, a cystic structure separate from the gallbladder representing the choledochal cyst was shown. The diagnosis of atresia of the distal common bile duct was made preoperatively in all cases by hepatobiliary scintigraphy. Diagnosis was confirmed by surgical findings and was demonstrated by intraoperative cholangiography in four cases. All patients were successfully treated with surgical intervention within 1 month from the time of diagnosis. Early detection of this rare disorder, which may be distinct from choledochal cyst found in children and adults, is important to prevent fatal complications of biliary obstruction. The combined use of sonography and hepatobiliary scintigraphy can correctly identify this subset of patients with persistent neonatal jaundice and provide valuable information for prompt surgical management.