CONGENITAL DILATATION OF THE BILE DUCT: CHANGES OF DIAGNOSTIC TOOLS
DURING A 19-YEAR EXPERIENCE
Takaya J, Muneyuki M, Tokuhara D, Takada K, Hamada Y,
Kobayashi Y
Kansai Medical University, Osaka, Japan
Objective: After the recent
improvement in diagnostic procedures, many cases of congenital dilatation
of the bile duct (CDBD) have been diagnosed in early life. We determined
the mode of presentation, the changes of diagnostic tools, and a long-term
outcome of CDBD patients after surgery. Patients: Thirty-four children (25 girls, 9 boys) with CDBD
treated between 1988 and 2000 were reviewed. The age at presentation ranged
from 0-16 (median 4.6) years, with two patients being diagnosed by prenatal
ultrasonography.
Results: Of the 32 patients
diagnosed postnatally, 10 presented with jaundice, associated with
abdominal pain (3 patients), 19 (59%) presented with pain alone, and 3
(9.4%) with a palpable mass. The average duration from presentations to
diagnosis has been shortened from 40 days to 14 days during the above
period. The finding of a dilated common bile duct at abdominal
ultrasonography is helpful for early diagnosis. Endoscopicretrograde
cholangiopancreatography (ERCP) and scintigraphy were used in the early
period, whereas the recent use of magnetic resonance
cholangiopancreatography (MRCP) and dimensional CT have increased the
diagnostic accuracy of CDBD. Anomalous pancreaticobiliary junction (PBJ)
was highly present in the patients with CDBD (44% was certified by imaging
studies). MRCP is noninvasive and useful for the preoperative diagnosis of
PBJ.
Conclusion: MRCP is a noninvasive
and accurate method for diagnosing anomalous PBJ and CDBD. It provides
better cholangiograms and may replace ERCP.