Perforation: a rare complication of choledochal cysts in children

Abstract

Hyperbilirubinaemia and remote free intra-peritoneal fluid allude the diagnosis of perforated CDC. When presenting with cholangitis, it warrants timely surgical intervention to prevent perforation. Single-staged or two-staged surgical approach would depend on stability of patient and surgical expertise available. Reversible dilatation of intra-hepatic duct suggests that increased intra-ductal pressure is a contributing factor to the perforation.

Spontaneous biliary peritonitis: Is bed side diagnosis possible?

“…[14] Main presenting features in our series were progressive abdominal distension, clinically evident jaundice with failure to thrive and recent change in color of stool which is contrary to the recently published series where most common presenting features were pain [10] and vomiting. [14] Although early diagnosis of SPBD is essential for immediate surgical management and better prognosis, it is a challenging process because perforation presents with non-specific symptoms hence imaging is important to differentiate this condition from other causes of obstructive jaundice. Biochemical studies usually reveal conjugated hyperbilirubenemia with near normal transaminase with elevated serum gamma-glutamyl transpeptidase and alkaline phosphates indicating obstructive jaundice.…”

“…If further cholangiography (either cholangiogram by T -tube or by MRCP) is suggestive of choledochal cyst biliary intestinal anastomosis is necessary to prevent biliary cirrhosis, portal hypertension, recurrent pancreatitis and ultimately biliary carcinoma. However, this can be done at a second laparotomy when inflammation has settled, though recently few authors had recommended single stage repair for this entity [14] with promising result but it should be attempted if patients present very early after perforation and proper expertise for this type of surgery is available. In our series we did not attempt for definitive surgery because all patients presented after 4 days of suspected perforation.…”

Spontaneous perforation of a choledochal cyst, clues for diagnosis

“…Hepatobiliary scintigraphy with 99m Tc iminodiacetic acid derivatives may be diagnostic in cases of bile duct perforation [10,12]. The presence of bile in the peritoneal cavity associated with obstructive jaundice in the absence of liver derangement is considered pathognomonic for bile duct perforation [14]. The presence of bile in the peritoneal cavity associated with obstructive jaundice in the absence of liver derangement is considered pathognomonic for bile duct perforation [14].…”

Koledok kistlerinden kaynaklanan kolanjiokarsinom: Olgu Sunumları

“…The malignant change occurs mainly within the choledochal cyst, but may occur in the gallbladder, pancreatic duct, or intrahepatic bile ducts (22). The risk of cholangiocarcinoma remains high when an internal drainage procedure has been performed and the cyst has been partially resected or left unresected (15). Nodular wall thickening and/or an enhancing mass in a choledochal cyst are highly suspicious of malignant change (23,24).…”

“…US has been the imaging modality of choice in children, whereas ERCP was used most commonly in adults. Percutaneous liver biopsy is contraindicated because of the risks of biliary injury and peritonitis (11,15,16).…”