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[Bile duct stricture in childhood. A diagnostic challenge (author's transl)]
Insights
Bile duct stricture is a rare cause of childhood cholestatic jaundice. Percutaneous transhepatic cholangiography is more accurate than ultrasound for diagnosis, aiding successful surgical repair.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Bile duct stricture is an uncommon cause of cholestatic jaundice in pediatric patients.
- Congenital, malignant, and traumatic etiologies contribute to pediatric biliary strictures.
- Early diagnosis and intervention are crucial for managing cholestasis in children.
Observation:
- This report details 5 cases of pediatric biliary stricture (3 congenital, 1 malignant, 1 blunt traumatic).
- Jaundice was present in 4 patients, with delayed onset in 2.
- Elevated alkaline phosphatases were noted, but initial ultrasound findings were negative in 3 cases.
Findings:
- Percutaneous cholangiography (2 cases) and per-operative cholangiography (3 cases) were essential for diagnosis.
- Roux en Y hepaticojejunostomy was successfully performed in 4 out of 5 patients.
- Percutaneous transhepatic cholangiography demonstrated superior accuracy compared to ultrasonography in diagnosing childhood cholestasis.
Implications:
- Percutaneous transhepatic cholangiography is a valuable tool for investigating cholestasis in pediatric patients.
- Prompt diagnosis of biliary strictures can lead to successful surgical outcomes.
- Bile duct stricture, even secondary to blunt trauma, requires careful diagnostic consideration in children.
Abstract:
5 cases of biliary stricture, 3 congenital, 1 malignant and 1 blunt traumatic are reported in 3 infants and 2 children. Jaundice is present in 4 patients only and is delayed in 2. Alkalin phosphatases are constantly elevated but ultrasound studies negative in 3 patients. Diagnosis was made by percutaneous cholangiography in 2 and per-operative cholangiogram in 3. Roux en Y hepaticojejunostomy is successfully performed in 4. Bile duct stricture is a rare cause of cholestatic jaundice in childhood and an even rarer sequela of blunt trauma. This series demonstrates the usefulness of percutaneous transhepatic cholangiography, more accurate than ultra-sonography in investigating cholestasis in childhood.