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Asymptomatic Bile Duct Dilatation in Children: Is It a Disease?

  • Son, Yeo Ju (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Lee, Mi Jung (Department of Radiology, Yonsei University College of Medicine) ;
  • Koh, Hong (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Kim, Seung (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
  • Received : 2015.07.22
  • Accepted : 2015.09.02
  • Published : 2015.09.30

Abstract

Purpose: Bile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children. Methods: We performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients. Results: Pediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy. Conclusion: Biliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.

Keywords

References

  1. Gore RM, Levine MS. Textbook of gastrointestinal radiology. Philadelphia: Elsevier, 2015.
  2. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2012.
  3. Bowie JD. What is the upper limit of normal for the common bile duct on ultrasound: how much do you want it to be? Am J Gastroenterol 2000;95:897-900. https://doi.org/10.1111/j.1572-0241.2000.01925.x
  4. Oppong KW, Mitra V, Scott J, Anderson K, Charnley RM, Bonnington S, et al. Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct. Scand J Gastroenterol 2014;49:473-80. https://doi.org/10.3109/00365521.2014.881547
  5. Bruno M, Brizzi RF, Mezzabotta L, Carucci P, Elia C, Gaia S, et al. Unexplained common bile duct dilatation with normal serum liver enzymes: diagnostic yield of endoscopic ultrasound and follow-up of this condition. J Clin Gastroenterol 2014;48:e67-70. https://doi.org/10.1097/MCG.0b013e3182a8848a
  6. Jeon J, Song SY, Lee KT, Lee KH, Bae MH, Lee JK. Clinical significance and long-term outcome of incidentally found bile duct dilatation. Dig Dis Sci 2013;58:3293-9. https://doi.org/10.1007/s10620-013-2792-9
  7. Lin SF, Lee HC, Yeung CY, Jiang CB, Chan WT. Common bile duct dilatations in asymptomatic neonates: incidence and prognosis. Gastroenterol Res Pract 2014;2014:392562.
  8. Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD, et al; ASGE Standards of Practice Committee. Role of EUS. Gastrointest Endosc 2007;66:425-34. https://doi.org/10.1016/j.gie.2007.05.026
  9. Fernandez-Esparrach G, Gines A, Sanchez M, Pages M, Pellise M, Fernandez-Cruz L, et al. Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study. Am J Gastroenterol 2007;102:1632-9. https://doi.org/10.1111/j.1572-0241.2007.01333.x
  10. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochal cyst disease. A changing pattern of presentation. Ann Surg 1994;220:644-52. https://doi.org/10.1097/00000658-199411000-00007
  11. Park HJ, Shin CG, Moon JS, Lee CG. Analysis of hepatobiliary disorders from a nationwide survey ofdischarge data in Korean children and adolescents. Korean J Pediatr Gastroenterol Nutr 2009;12:16-22.
  12. Zhang Y, Wang XL, Li SX, Bai YZ, Ren WD, Xie LM, et al. Ultrasonographic dimensions of the common bile duct in Chinese children: results of 343 cases. J Pediatr Surg 2013;48:1892-6. https://doi.org/10.1016/j.jpedsurg.2012.11.047
  13. Douillet P, Brunelle F, Chaumont P, Valayer J, Sassoon C, Odievre M. Ultrasonography and percutaneous cholangiography in children with dilated bile ducts. Report of six cases. Am J Dis Child 1981;135:131-3. https://doi.org/10.1001/archpedi.1981.02130260023007
  14. Arima E, Akita H. Congenital biliary tract dilatation and anomalous junction of the pancreatico-biliary ductal system. J Pediatr Surg 1979;14:9-15. https://doi.org/10.1016/S0022-3468(79)80569-2
  15. Buyukyavuz I, Karnak I, Haliloglu M, Senocak ME. Inflammatory myofibroblastic tumour of the extrahepatic bile ducts: an unusual cause of obstructive jaundice in children. Eur J Pediatr Surg 2003;13:421-4. https://doi.org/10.1055/s-2003-44736
  16. Tas A, Koklu S. Unusual cause of common bile duct dilatation in asymptomatic elderly patient: right hepatic artery syndrome. Ann Hepatol 2012;11:150-1.
  17. Tahara K, Ishimaru Y, Fujino J, Suzuki M, Hatanaka M, Igarashi A, et al. Association of extrahepatic bile duct duplication with pancreaticobiliary maljunction and congenital biliary dilatation in children: a case report and literature review. Surg Today 2013;43:800-5. https://doi.org/10.1007/s00595-012-0262-1
  18. McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology 1982;144:873-5. https://doi.org/10.1148/radiology.144.4.7111740
  19. Hernanz-Schulman M, Ambrosino MM, Freeman PC, Quinn CB. Common bile duct in children: sonographic dimensions. Radiology 1995;195:193-5. https://doi.org/10.1148/radiology.195.1.7892467
  20. Siegel MJ. Liver and biliary tract. In: Siegel MJ, ed. Pediatric sonography. 2nd ed. New York: Raven Press, 1995:171.
  21. Naji O, Hussain A, Baker D, Habib N, El-Hasani S. Obstructive jaundice due to autoimmune cholangiopathy. BMJ Case Rep 2009;2009.
  22. Fumino S, Iwai N, Deguchi E, Shimadera S, Iwabuchi T, Nishimura T, et al. Bleeding tendency as a first symptom in children with congenital biliary dilatation. Eur J Pediatr Surg 2007;17:2-5. https://doi.org/10.1055/s-2007-964928
  23. Riederer J. Obstructive jaundice du to sludge in the common bile duct. Dtsch Med Wochenschr 2000; 125:11-4. https://doi.org/10.1055/s-2007-1023877
  24. Senturk S, Miroglu TC, Bilici A, Gumus H, Tekin RC, Ekici F, et al. Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT. Eur J Radiol 2012;81:39-42. https://doi.org/10.1016/j.ejrad.2010.11.007
  25. Landry D, Tang A, Murphy-Lavallee J, Lepanto L, Billiard JS, Olivie D, et al. Dilatation of the bile duct in patients after cholecystectomy: a retrospective study. Can Assoc Radiol J 2014;65:29-34. https://doi.org/10.1016/j.carj.2012.09.004
  26. Daradkeh S, Tarawneh E, Al-Hadidy A. Factors affecting common bile duct diameter. Hepatogastroenterology 2005;52:1659-61.
  27. Lee HC, Yeung CY, Chang PY, Sheu JC, Wang NL. Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance. J Ultrasound Med 2000;19:177-82; quiz 183-4. https://doi.org/10.7863/jum.2000.19.3.177
  28. Kim JE, Lee JK, Lee KT, Park DI, Hyun JG, Paik SW, et al. The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography. Endoscopy 2001; 33:495-500. https://doi.org/10.1055/s-2001-15088

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