Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation

Fukuzawa, Hiroaki; Urushihara, Naoto; Miyakoshi, Chisato; Kajihara, Keisuke; Kawahara, Insu; Isono, Kaori; Samejima, Yoshitomo; Miura, Shizu; Uemura, K; Morita, Keiichi; Nakao, Makoto; Yokoi, Akiko; Fukumoto, Koji; Yamoto, Masaya; Murakami, Kosaku

doi:10.1007/s00383-018-4321-6

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…When all cases were included, there was higher percentage of cystic cases in group 2 than in group 1 with significant difference. This result was consistent with Ando et al (7) and Fukuzawa et al (11) reports. The mechanism of high perforation rate in fusiform cases is still unknown.…”

Section: Discussionsupporting

confidence: 93%

“…Perforation of a choledochal cyst (CC) is not rare, with a reported frequency ranging from 1.8 to 18% (7)(8)(9)(10). The pathogenesis of spontaneous perforation has not been established, but proposed mechanisms include reflux of pancreatic secretions (8), increased intraluminal pressure due to protein plugs (7,11), and viral infection (12). PBM is the cause of regurgitation between the bile and pancreatic ducts.…”

Section: Introductionmentioning

confidence: 99%

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Type C Pancreaticobiliary Maljunction Is Associated With Perforated Choledochal Cyst in Children

Zhu

Xiong

et al. 2020

Front. Pediatr.

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Background: Perforation of a choledochal cyst (CC) is not rare, but the pathogenesis of spontaneous perforation has not been established. Pancreaticobiliary maljunction (PBM) is commonly seen in association with choledochal cyst. To explore the relationship between PBM and perforated CC, a retrospective study was conducted. Methods: We analyzed all the patients with CC who underwent surgery in our hospital from 2014.06.01 to 2018.12.31. All patients were divided into two groups: group 1 were patients with perforated CC, and group 2 were patients with non-perforated CC. We recalled all the patients records to identify types of PBM. PBM was divided into four types [(A) stenotic type, (B) non-stenotic type, (C) dilated channel type, and (D) complex type] according to the classification proposed by the Committee on Diagnostic Criteria of the Japanese Study Group on Pancreaticobiliary Maljunction (JSGPM) in 2015. Results: There were 186 patients with CC in all, and 116 patients showed PBM. Twenty patients in group 1 and 96 patients in group 2. There was an extremely higher percentage of type C PBM in group 1 than in group 2 (60 and 17.7%, respectively). More fusiform dilatation cases were found in group 1 (70%) than in group 2 (58.3%). Also there were more type C PBM in fusiform cases and type A PBM were frequently seen in cystic cases (P < 0.01). Conclusions: We found that Type C PBM and fusiform common bile duct maybe relate to the perforation of choledochal cyst. Patients with type C PBM and fusiform common bile duct should be treated more proactively, preferably before they perforate.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Type C Pancreaticobiliary Maljunction Is Associated With Perforated Choledochal Cyst in Children

Zhu

Xiong

et al. 2020

Front. Pediatr.

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“…The patients were followed up regularly after surgery. If symptoms such as abdominal pain, fever, biliary dilatation, obstruction, and PBM ( 7 , 15 , 16 ) were confirmed, hepaticojejunostomy was performed.…”

Section: Methodsmentioning

confidence: 99%

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

et al. 2022

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ObjectiveThis study aimed to explore the etiology, clinical features, diagnosis, and treatment of spontaneous bile duct perforation (SBDP) in children.MethodsThe clinical data of children with SBDP who were admitted to Wuhan Children's Hospital between January 2014 and January 2020 were retrospectively analyzed.ResultsIn all, 28 cases of children with SBDP (male, 28.6%; female, 71.4%; male-to-female ratio, 1:2.5; average age, 2.15 years) were analyzed. The most common symptoms were fever (85.7%), nausea and vomiting (78.6%), and abdominal distension (67.9%). Among the 28 patients, 26 (92.9%) had elevated hypersensitive C-reactive protein, 24 (85.7%) had an increased neutrophil percentage, and 22 (78.6%) had raised peripheral blood leukocyte counts. Moreover, 19 patients (67.9%) showed increased serum total bilirubin levels, and 5 (17.9%) showed an elevated conjugated bilirubin level. Abdominal CT examination revealed that the gallbladder wall of patients was thickened with edema, accompanied by gallbladder stenosis and gallbladder mucosa enhancement; furthermore, ascites was found in the abdominal cavity and lesser omental bursa. Twenty-two patients underwent abdominal paracentesis, and 20 (90.9%) of them were exposed to bile-based ascites. Among the 28 patients, four recovered with conservative treatment, whereas the others (85.7%) were surgically treated. Of the twenty-four patients undergoing surgery, the perforation site was found at the union of the hepatic and cystic ducts in 12 patients (50%), no perforation site was observed in 9 patients (37.5%), and a common hepatic duct was observed in 3 patients (12.5%). All 24 patients underwent stage I surgery, and temporary biliary drainage was performed because of severe abdominal inflammation. Cholangiography and enhanced CT revealed an abnormal location of the pancreatic duct joining the bile duct in 64.3% patients. Following surgery, 15 patients underwent hepaticojejunostomy. Subsequently, 3-month to 6-year follow-up (median, 30 months) indicated that the patients recovered well with no serious complications.ConclusionSBDP in children may be associated with pancreaticobiliary malunion (PBM) and congenital weakness of the bile duct wall. However, the clinical manifestations of this condition lack specificity; this limitation can be assisted through diagnosis via abdominal CT and by performing abdominal paracentesis. Once SBDP diagnosis is confirmed, the patient should follow the principles of individualized treatment.

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“…Therefore, a majority of the perforation cases were distributed in children younger than 4 years 5 . In this case as well, she was 1 year and 4 months old.…”

Section: Post-admission Coursementioning

confidence: 99%

Usefulness of Thin-Slice Contrast-Enhanced Computed Tomography in Detecting Perforation Site in Congenital Biliary Dilatation: A Case Report

et al. 2022

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The site of perforation is difficult to identify preoperatively in many cases with spontaneous perforation of congenital biliary dilatation (CBD). We report a case of spontaneous perforation of CBD in which the perforation site was identified preoperatively using thin-slice contrast-enhanced computed tomography (CT). The patient was a girl aged 1 year and 4 months. She was admitted to our hospital because of vomiting and diarrhea that had continued for 3 days prior to admission. Abdominal contrast CT on admission showed dilated common bile duct, thickening of the gall bladder wall, and marked ascites. In addition, an area of low density with a diameter of 1 cm was detected near the neck of the gallbladder. We evaluated the area via thin-slice contrast-enhanced CT and detected a defect in the wall of the bile duct. Cholangiography revealed abnormal confluence of the pancreaticobiliary duct and a protein plug in the common duct. A diagnosis of CBD with perforation of the bile duct was made, and surgery was performed. The intraoperative findings matched that seen on the enhanced CT. There are some reports of pseudocysts and fluid retention around the perforation site; however, no reports are found in which the perforation site was confirmed by preoperative CT. If localized fluid retention is observed in cases with biliary perforation, confirmation with thin-slice contrast-enhanced CT might be useful for identifying the perforation site.

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Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation

Cited by 13 publications

References 11 publications

Type C Pancreaticobiliary Maljunction Is Associated With Perforated Choledochal Cyst in Children

Type C Pancreaticobiliary Maljunction Is Associated With Perforated Choledochal Cyst in Children

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

Usefulness of Thin-Slice Contrast-Enhanced Computed Tomography in Detecting Perforation Site in Congenital Biliary Dilatation: A Case Report

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