Spontaneous Perforation of the Bile Duct in a Toddler: The Role of Endoscopic Retrograde Cholangiopancreatography in Diagnosis and Therapy

Barnes, Barrett H.; Narkewicz, Michael R.; Sokol, Ronald J.

doi:10.1097/01.mpg.0000233162.43409.ec

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…The typical presentation is of a previously well infant with an unremarkable antenatal history, who presents with abdominal distension and/or jaundice. Other symptoms include acholic stools, vomiting, fever and poor weight gain [11][12][13]. Although the constellation of symptoms might raise concern of biliary atresia, the previously asymptomatic history should rather cause suspicion of a SBP.…”

Section: Discussionmentioning

confidence: 97%

“…Some authors do not recommend exploration of the porta hepatis as inflammation significantly increases technical difficulty [21]. Endoscopic retrograde cholangiopancreatography has been used in both diagnostic and therapeutic modalities [11,22]. However, there are significantly limited resources and qualified personnel capable of investigating and treating paediatric SBP with endoscopic retrograde cholangiopancreatography.…”

Section: Discussionmentioning

confidence: 99%

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Paediatric infant presenting with an atypical spontaneous biliary perforation

Ofri¹,

Jiwane²

2014

Annals of Pediatric Surgery

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Paediatric infant presenting with an atypical spontaneous biliary perforation

Ofri¹,

Jiwane²

2014

Annals of Pediatric Surgery

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“…A previous report has stated that a hepatic iminodiacetic acid scan is a reliable test for showing the extravasation of bile and confirming a perforation [11]. Endoscopic instrumentation and techniques have evolved rapidly over the last few decades and have replaced laparotomy because of noninvasive technique and prognoisis after treatment [12–15]. Endoscopic treatment should have been performed if the patient had not developed shock and pan peritonitis.…”

Section: Discussionmentioning

confidence: 99%

T tube drainage for spontaneous perforation of the extrahepatic bile duct

et al. 2011

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SummaryBackgroundSpontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively.Case ReportA 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery.ConclusionsA more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient’s general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

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“…Based on the site of perforation, most perforations are situated anteriorly (at the junction of the cystic duct and the CBD) and can be controlled by adjacent structures. If that control fails, bile leaks into the peritoneal cavity, resulting in bilious ascites [34,35]. Clinically, patients complain of abdominal distension, vomiting, discoloration of hydroceles or hernia sacs, NC, and claycoloured stool.…”

Section: Spontaneous Biliary Duct Perforation (Sbdp)mentioning

confidence: 99%

“…Less commonly, there is an acute deterioration associated with sudden abdominal pain, abdominal distension, fever, and vomiting [30]. SBDP can be treated conservatively with broad-spectrum antibiotics [36], endoscopic retrograde pancreatography [34], and percutaneous transhepatic cholangiography [37]. Failed conservative therapy indicates the need for surgical intervention (biliary intestinal reconstruction) [38].…”

Section: Spontaneous Biliary Duct Perforation (Sbdp)mentioning

confidence: 99%

Neonatal cholestasis: recent insights

Ghazy

Khedr

2019

Egypt Pediatric Association Gaz

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Background: Neonatal physiological jaundice is a common benign condition that rarely extends behind the second week of life; however, it may interfere with the diagnosis of a pathological condition termed neonatal cholestasis (NC). The latter is a critical, uncommon problem characterized by conjugated hyperbilirubinaemia. This review aims to highlight the differences between physiological and pathological jaundice, identify different causes of NC, and provide a recent approach to diagnosis and management of this serious condition. Main text: NC affects 1/2500 live births, resulting in life-threatening complications due to associated hepatobiliary or metabolic abnormalities. NC is rarely benign and indicates the presence of severe underlying disease. If jaundice extends more than 14 days in full-term infants or 21 days in preterm infants, the serum bilirubin level fractionated into conjugated (direct) and unconjugated (indirect) bilirubin should be measured. A stepwise diagnostic approach starts with obtaining a complete history, and a physical examination which are valuable for the rapid diagnosis of the underlying disease. The most frequently diagnosed causes of NC are biliary atresia (BA) and idiopathic neonatal hepatitis (INH). The early diagnosis of NC ensures more accurate management and better prognosis. Despite the unavailability of any specific treatments for some causes of NC, the patient can benefit from nutritional management and early medical intervention. Future research should attempt to shed light on methods of screening for NC, especially for causes that can be effectively treated either through proper nutritional support, appropriate chemotherapeutic management, or timely surgical intervention. Conclusion: Further attention should be paid for diagnosis and treatment of NC as it may be misdiagnosed as physiological jaundice; this may delay the proper management of the underlying diseases and aggravates its complications.

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Spontaneous Perforation of the Bile Duct in a Toddler: The Role of Endoscopic Retrograde Cholangiopancreatography in Diagnosis and Therapy

Cited by 17 publications

References 21 publications

Paediatric infant presenting with an atypical spontaneous biliary perforation

Paediatric infant presenting with an atypical spontaneous biliary perforation

T tube drainage for spontaneous perforation of the extrahepatic bile duct

Neonatal cholestasis: recent insights

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