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Dilatation of the biliary tract in pediatric patients
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Insights
Biliary tract dilatation in children, primarily Type I cysts, presents with varied symptoms. Real-time sonography accurately diagnosed all cases, guiding surgical treatment and improving outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Biliary tract dilatation (choledochal cysts) is a congenital anomaly affecting infants and children.
- Diagnosis and management are crucial for preventing complications like cholangitis and malignancy.
Purpose of the Study:
- To review the clinical presentations, diagnostic methods, and surgical outcomes of biliary tract dilatation in pediatric patients.
- To evaluate the efficacy of different imaging modalities in diagnosing these conditions.
Main Methods:
- Retrospective analysis of 40 pediatric cases diagnosed and treated between 1980 and 1992.
- Review of clinical data, laboratory tests, liver function tests, and imaging findings (ultrasound, Tc-99m DISIDA scan, CT).
- Classification of biliary tract dilatation according to Todani's system.
Main Results:
- Type I choledochal cysts were most common (87.5%).
- Abdominal pain, jaundice, and vomiting were frequent symptoms, but the classic triad was rare (7.5%).
- Real-time sonography achieved 100% diagnostic accuracy; Tc-99m DISIDA scan and CT had high accuracy rates (88% and 100%, respectively).
Conclusions:
- Biliary tract dilatation in children requires prompt diagnosis and surgical intervention.
- Sonography is a highly effective imaging tool for diagnosis.
- Type I cysts are prevalent, and surgical management leads to generally favorable outcomes with manageable complications.
Abstract:
Forty cases of dilatation of the biliary tract in infants and children were diagnosed and treated at the Veterans General Hospital, Taipei and Taichung between 1980 and 1992. The male to female ratio was 1:2.6 and the age ranged from 1 day to 14 years. Major clinical presentations were abdominal pain (57.5%), jaundice (42.5%), vomiting (37.5%) and abdominal mass (30%); the classical triad of abdominal pain, jaundice and abdominal mass occurred in only three cases (7.5%). Abnormal liver function tests included elevated bilirubin (Bil) (22/37), aminotransferase (30/40), alkaline phosphatase (Alk-P) (34/37), lactic dehydrogenase (LDH) (22/34) and gamma-glutamyl transpeptidase (GGT) (13/15). The amylase in bile was detected in 16 cases with 10 cases higher than 500 Somogyi units/dL. All cases were diagnosed correctly, using real time sonography. Technetium-labeled scintiscan (Tc-99m DISIDA scan) was interpreted correctly in 88% (15/17) and abdominal computerized tomography (CT) in 10 cases (10/10). According to Todani's classification, type I cyst was the most common (35 cases, 87.5%) and the remaining cases were type IV-A (3 cases) and type V (2 cases). Operation was performed in 38 cases except for two who had type V dilatation of biliary tract (Caroli's disease). Complications included rupture of the gall bladder in two patients and common bile duct stone in one; mortality after operation occurred in one case. Surgical specimens of the liver revealed periportal fibrosis in nine instances.