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Spontaneous perforation of the common bile duct in children
J O Haller1, V R Condon, W E Berdon
1Department of Radiology, SUNY Downstate Medical Center, Brooklyn 11203.
Insights
Spontaneous perforation of the common bile duct is rare in children. Radiologic findings like ascites and specific gallbladder fluid collections on ultrasound, confirmed by scintigraphy, aid diagnosis.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Surgical Pediatrics
Background:
- Spontaneous perforation of the common bile duct (CPD) is a rare but serious condition in infants and children.
- It often presents with non-specific symptoms such as jaundice and abdominal distention, leading to diagnostic challenges.
Purpose of the Study:
- To describe the characteristic radiologic findings of spontaneous perforation of the common bile duct in pediatric patients.
- To highlight the utility of ultrasound and hepatobiliary scintigraphy in diagnosing this condition.
Main Methods:
- Retrospective review of radiologic findings in five pediatric patients diagnosed with spontaneous perforation of the common bile duct.
- Sonography, hepatobiliary scintigraphy, and intraoperative cholangiography were utilized for diagnosis.
Main Results:
- Common presenting symptoms included jaundice and abdominal distention due to ascites.
- Sonographic findings frequently revealed ascites and/or loculated fluid collections around the gallbladder.
- The biliary tree remained undilated in all cases.
- Hepatobiliary scintigraphy confirmed intraperitoneal fluid originating from the biliary tract.
Conclusions:
- Radiologic findings, particularly on ultrasound and confirmed by scintigraphy, are crucial for early diagnosis of spontaneous perforation of the common bile duct in children.
- Prompt diagnosis and surgical intervention are essential for successful treatment and to prevent potentially fatal outcomes.
Abstract:
The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonographic findings included ascites in three patients, a loculated fluid collection around the gallbladder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.