Surgical biliary tree pathologies in paediatric patients

ABSTRACT

To find out various pathologies affecting biliary tree in paediatric age group and mode of investigations performed to arrive at diagnosis. Descriptive case series. Department of Paediatric Surgery Unit B, National Institute of Child Health Karachi, from January 2007 to December 2007. All paediatric patients below the age of 12 years who presented with symptoms related to biliary tree were included. A detailed history was taken including presence of jaundice, color of stool, mass an pain in right upper abdomen etc. all wee subjected to ultrasound as a screening test. Laboratory investigations included blood complete picture, liver function tests including bleeding profile, TORCH titre where appropriate, HIDA scan and CT scan as indicated. Laparoscopy was done in cases with persistent jaundice for operative cholangiogram and liver biopsy. Surgical procedure was tailored according to the pathology found. A total of 18 patients were managed. The number of male and female patients was nine each. The ages of the patients ranged from one month to nine years. Most common pathology was biliary atresia [n7]. Eleven patients presented wit persistent jaundice with age range from one month to 18 months. In all them HIDA scan showed failure of visualization of excretion of contrast into duodenum. All underwent laparoscopy and in seven of these biliary atresia found. There were four patients in whom extrahepatic biliary tree was found patent on cholangiogram. They were in older age range [from three months to 18 months]. All had grossly cirrhotic liver. Three patients had choledochal cyst [two males and one female]. The age ranged from 1 1/2 month to 9 year. A female of 2 1/4 year presented with history of fever and failure to thrive. Ultrasound showed presence of gall stones. Cholecystectomy was done in this child. Three patients had common bile duct [CBD] pathology. All had history of fever, recurrent jaundice with dilated CBD on ultrasound. All had CBD stone/ sludge. In two choledochotomy and removal of stone/ sludge was done while other had cholecystectomy in addition because of inflamed gall bladder. No T tube was places. One patient with idiopathic variety of gall stone had cholecystectomy. Ultrasound in expert hands is a good screening test in patients suspected of having surgical biliary tree pathology. HIDA scan can be safely omitted from list of investigations and laparoscopy is recommended in all cases of prolonged neonatal jaundice where surgical pathology is suspected