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[Common bile duct syndrome in children]
U Tannuri1, P T Sakane, H H Marques
1Disciplina de Cirurgia Pediátrica, FMUSP.
Insights
Anomalous pancreaticobiliary ductal junction can cause bile duct dilatation in children. Surgical treatment, Roux-en-Y hepatico-jejunostomy, effectively resolves symptoms and ensures recovery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Anatomical Abnormalities
Background:
- Anomalous pancreaticobiliary ductal junction (APBDJ) is a rare congenital condition.
- This anatomical variation involves a long common channel between the pancreatic and bile ducts, leading to potential reflux.
- Reflux of pancreatic enzymes into the biliary tree can cause significant complications.
Observation:
- Two pediatric cases of bile duct dilatation secondary to APBDJ were analyzed.
- Clinical presentations included upper abdominal pain, vomiting, and jaundice.
- Diagnostic methods involved abdominal ultrasonography and cholangiography (endoscopic or intra-operative).
Findings:
- The anatomical abnormality, a long common channel, facilitates pancreatico-biliary reflux.
- Bile duct dilatation was the primary observed consequence.
- Roux-en-Y hepatico-jejunostomy was identified as the optimal surgical intervention.
Implications:
- Prompt diagnosis and surgical intervention are crucial for managing APBDJ in children.
- Roux-en-Y hepatico-jejunostomy offers a successful treatment for bile duct dilatation caused by APBDJ.
- Effective management leads to symptom resolution and favorable long-term outcomes in affected children.
Abstract:
Two children bile duct dilatation due to anomalous junction of the pancreato-biliary ductal system are reported. A long common channel comes out of the duodenal wall and, thus, reflux of pancreatic juice into the biliary tree and dilatation of biliary ducts may occur. Clinical findings were upper abdominal pain, vomiting, or jaundice. Diagnosis was accomplished by abdominal ultrasonography and endoscopic or intra-operative colangiography. Both cases were treated by Roux-en-Y hepatico-jejunostomy, the best technique for these cases. Follow-up showed that the patients are well and free of symptoms.