Z Gastroenterol 2008; 46 - A46
DOI: 10.1055/s-2008-1079650

Bile duct diseases in infancy and children

M Kovács 1, L Szőnyi 4, A Dezsőfi 4, S Davidovics 2, I Rácz 3
  • 1Petz Aladár County and Teaching Hospital, Győr, Department of Pediatrics
  • 2Department of Pediatric Surgery
  • 31st Depatment of Medicine and Gastroenterology
  • 4Semmelweis University, Budapest, 1st Department of Pediatrics

Background: The bile duct diseases may induce cholestasis with or without jaundice. In neonate and infancy the extra- and intrahepatic bile duct diseases may occur with the same clinical symptoms. In adolescent children the extrahepatic bile duct alterations are more frequent.

Aim: The purpose of this retrospective study was to analyze the causes of bile duct diseases and to evaluate the steps of the diagnostic activity as well as the applied treatment.

Patients and methods: From January 2000 to October 2007 we investigated 17 children with bile duct diseases. The age of our patients ranged from 6 months to 16 years with a median age of 10.9 years. The gender ratio was 8 females to 9 males. We reviewed the medical records retrospectively.

Results: The extrahepatic bile ducts were affected in 14 patients, while in three patients the intrahepatic bile ducts were altered. In 11 patients common bile duct stones with gallbladder stones were identified. The diagnoses of bile duct stones were confirmed in 8 patients by non-invasive methods (US, MRCP) and in three patients by ERCP. All in these patients preoperative therapeutic ERCP and cholecystectomy was performed. Stenoses of the extrahepatic bile duct was detected in three patients. In the case of the portal vein cavernosus malformation resulting secondary stenosis of the common bile duct surgery by a Roux-en Y choledochojejunostomy was done. The common bile duct stenosis caused by recurrent pancreatitis was operated on using the same technique. In one patient the Wilson-disease with underlying lymphadenomegaly caused suprapapillary choledochus stenosis, which was treated by common bile duct stenting. In three cases intrahepatic bile duct diseases were verified by the liver biopsy histology.

Conclusions: In our extrahepatic cholestasis cases the diagnostic value of the non-invasive imaging methods (US, MRCP) was high. CT scan is the most informative method to study the source of bile duct compression. ERCP was performed mainly with therapeutic aims. Liver biopsy is essential to clarify the etiology of intrahepatic cholestasis.