Postnatal management of prenatally diagnosed biliary cystic malformation

Tanaka, Hiromu; Sasaki, Hideyuki; Wada, Mitsuru; Sato, Tomoyuki; Kazama, Tomohiko; Nishi, Kotaro; Kaneko, Hironori; Nakamura, Megumi; Nio, Masaki

doi:10.1016/j.jpedsurg.2014.08.002

Cited by 33 publications

(23 citation statements)

References 13 publications

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“…The study also showed the highest accuracy with a significant diagnostic performance for differentiating CBA from CC was cyst size, followed by the DBIL and TBA. As reported previously in our studies, this study showed that different laboratory and ultrasonographic parameters have significant diagnostic values for differentiating CBA from CC, but no single test showed 100% sensitivity and specificity. There is still certain difficulty in the early identification of CBA and CC clinically.…”

Section: Discussionsupporting

confidence: 82%

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Tang

Zhang

Liu

et al. 2017

J Paediatrics Child Health

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Section: Discussionsupporting

confidence: 82%

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Tang

Zhang

Liu

et al. 2017

J Paediatrics Child Health

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“…This hypothesis is unlikely given that there are several reports of CC diagnosed antenatally prior to 25 weeks' gestation and no reports of spontaneous resolution, however the knowledge base is limited. [8,18] Finally, there have been reports of spontaneous resolution of noncystic CBD dilatations related to TPN-induced biliary sludge, however this finding was not present in our patient. [19] …”

Section: Discussioncontrasting

confidence: 53%

“…[7] Asymptomatic antenatal diagnosis has been documented as early as 20-week gestational age. [8,9] Complications at the time of presentation include cholangitis, pancreatitis, portal hypertension, and elevation of serum liver enzymes. [2] Long-term complications include biliary cancer in as many as 20%-30% of patients.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous resolution of choledochal cyst

et al. 2017

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Choledochal cysts (CCs) are rare, congenital cystic dilations of the hepatobiliary tree that require surgical resection to avoid complications such as increased risk of malignancy. A 25-week gestational age male infant developed acholic stools, elevated alkaline phosphatase, and ultrasound findings consistent with CC Todani Type IVA. Surgery was deferred due to the patient's low weight. The patient's symptoms and radiographic findings subsequently resolved spontaneously. CCs have not been previously reported in extremely preterm infants. There are rare reported cases of spontaneously resolving hepatic cysts, all containing key differences from our patient. In patients in whom immediate surgery is not feasible, conservative management with close follow-up and serial ultrasound examinations would appear to be a reasonable course of action.

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“…71 Yet, Lugo-Vicente 72 in an article published in 1995 already recommended close monitoring of asymptomatic infants and timing elective surgery when anesthetic risk was minimized. Other authors have been more specific as far as the timing of surgery is concerned, proposing to treat asymptomatic children with CCM in the neonatal period, 71 before 2 months of age 73,74 while others suggest the age of three or even 6 months to be the ideal time for definitive surgical correction. 5,75,76 In summary, it seems difficult to give clear advice for when children with asymptomatic CCM should be operated on and benefits and risks must be carefully counterbalanced.…”

Section: General Considerationsmentioning

confidence: 99%

Perioperative Complications in Neonatal Surgery: Biliary Atresia and Choledochal Malformations

2018

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Biliary atresia (BA) and congenital choledochal malformations (CCM) are rare. Both pathologies must (BA) or may (CCM) be operated during the neonatal period or early infancy. We briefly describe the classical operative techniques for both pathologies, followed by the most common and severe perioperative complications encountered during and up to 30 days after surgery in children operated for BA and CCM early in life. For patients with BA, intestinal complications represent the most common and hazardous perioperative surgical complications. Cholangitis is the most frequently encountered medical complication post hepato-porto-enterostomy. For CCM, it seems that neonates encounter little perioperative complications; however, reports are scarce; bile leak and/or cholangitis are the most reported. Overall, for patients with CCM, the literature is ambivalent whether more perioperative complications occur in the younger or in the older patient, and whether these occur more frequently in those symptomatic or asymptomatic at operation. It is difficult to give clear advice for when children with asymptomatic CCM should be operated, and benefits and risks must be carefully counterbalanced. Perioperative mortality for both BA and CCM is low and is reported to be around 1 to 2%.

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Postnatal management of prenatally diagnosed biliary cystic malformation

Cited by 33 publications

References 13 publications

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Spontaneous resolution of choledochal cyst

Perioperative Complications in Neonatal Surgery: Biliary Atresia and Choledochal Malformations

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