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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
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Standardization of common bile duct size using ultrasound in pediatric patients

Erika B Lindholm1, Teerin Meckmongkol1, Ari J Feinberg2

  • 1Division of Pediatric General, Thoracic and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Philadelphia, PA.

Journal of Pediatric Surgery
|March 30, 2019
PubMed

Insights

Establishing normal common bile duct (CBD) size in children using ultrasound is crucial for diagnosing obstruction. Pediatric CBD diameters are significantly smaller than adult norms, improving diagnostic accuracy for choledocholithiasis.

Area of Science:

  • Pediatric Gastroenterology
  • Diagnostic Imaging
  • Hepatobiliary Surgery

Background:

  • The incidence of choledocholithiasis (gallstones in the common bile duct) is rising.
  • Accurate diagnosis of common bile duct (CBD) obstruction relies on measuring CBD diameter.
  • Current diagnostic criteria often use adult norms, potentially leading to inaccuracies in pediatric cases.

Purpose of the Study:

  • To establish normative values for common bile duct (CBD) size in children across different age groups using ultrasound.
  • To validate these pediatric norms against cases of confirmed choledocholithiasis.
  • To improve the diagnostic accuracy for CBD obstruction in pediatric patients.

Main Methods:

  • Retrospective review of ultrasounds (US) in patients under 21 years old.
  • Stratification of patients into age groups (<1 year, 1-10 years, >10 years) for analysis.
  • Comparison of normal cohort CBD sizes with those of patients diagnosed with choledocholithiasis.

Main Results:

  • A cohort of 778 patients without pathology established normal CBD size ranges: <1 year (1.24±0.54 mm), 1-10 years (1.97±0.71 mm), and >10 years (2.98±1.17 mm).
  • Patients with choledocholithiasis (n=14) had a mean CBD size of 8.1 mm, with all falling outside the established pediatric normal range.
  • Only 50% of choledocholithiasis cases showed enlarged CBD size when compared to adult norms, highlighting the inadequacy of adult standards for children.

Conclusions:

  • Normal common bile duct (CBD) size in children is considerably smaller than in adults.
  • Implementing age-specific pediatric CBD size norms enhances the diagnostic accuracy for identifying CBD obstruction.
  • These findings will aid clinicians in determining the need for further evaluation in children with suspected CBD obstruction.
Abstract

Keywords:
CholedocholithiasisCommon bile ductPediatricUltrasound

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