Asymptomatic Bile Duct Dilatation in Children: Is It a Disease?
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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 ultra-sonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and ana-lyzed 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.
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 ultra-sonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and ana-lyzed 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.
참고문헌 (28)
- Gore RM, "Textbook of gastrointestinal radiology" (2015), Elsevier
- Brant WE, "Fundamentals of diagnostic radiology", pp.2012, Wolters Kluwer
- 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, 95, pp.897~900 (2000)
- Oppong KW, "Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct", Scand J Gastroenterol, 49, pp.473~480 (2014)
- Bruno M, "Unexplained common bile duct dilatation with normal serum liver enzymes: diagnostic yield of endoscopic ultrasound and follow-up of this condition", J Clin Gastroenterol, 48, pp.e67~70 (2014)
- Jeon J, "Clinical significance and long-term outcome of incidentally found bile duct dilatation", Dig Dis Sci, 58, pp.3293~3299 (2013)
- Lin SF, "Common bile duct dilatations in asymptomatic neonates:incidence and prognosis", Gastroenterol Res Pract, 2014, pp.392562~ (2014)
- Gan SI, "ASGE Standards of Practice Committee. Role of EUS", Gastrointest Endosc, 66, pp.425~434 (2007)
- Fernández-Esparrach G, "Comparison of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in the diagnosis of pancreatobiliary diseases: a prospective study", Am J Gastroenterol, 102, pp.1632~1639 (2007)
- Lipsett PA, "Choledochal cyst disease. A changing pattern of presentation", Ann Surg, 220, pp.644~652 (1994)
- 박현주, "전국 퇴원자료조사를 통한소아청소년 간담도 질환의 분석", Pediatric Gastroenterology, Hepatology & Nutrition, 12(1), pp.16~22 (2009), 대한소아소화기영양학회
- Zhang Y, "Ultrasonographic dimensions of the common bile duct in Chinese children: results of 343 cases", J Pediatr Surg, 48, pp.1892~1896 (2013)
- Douillet P, "Ultrasonography and percutaneous cholangiography in children with dilated bile ducts. Report of six cases", Am J Dis Child, 135, pp.131~133 (1981)
- Arima E, "Congenital biliary tract dilatation and anomalous junction of the pancreatico-biliary ductal system", J Pediatr Surg, 14, pp.9~15 (1979)
- Büyükyavuz I, "Inflammatory myofibroblastic tumour of the extrahepatic bile ducts: an unusual cause of obstructive jaundice in children", Eur J Pediatr Surg, 13, pp.421~424 (2003)
- Tas A, "Unusual cause of common bile duct dilatation in asymptomatic elderly patient: right hepatic artery syndrome", Ann Hepatol, 11, pp.150~151 (2012)
- Tahara K, "Association of extrahepatic bile duct duplication with pancreaticobiliary maljunction and congenital biliary dilatation in children: a case report and literature review", Surg Today, 43, pp.800~805 (2013)
- McGahan JP, "Sonography of the normal pediatric gallbladder and biliary tract", Radiology, 144, pp.873~875 (1982)
- Hernanz-Schulman M, "Common bile duct in children: sonographic dimensions", Radiology, 195, pp.193~195 (1995)
- Siegel MJ, "Pediatric sonography", pp.171~ (1995), Raven Press
- Naji O, "Obstructive jaundice due to autoimmune cholangiopathy", BMJ Case Rep, pp.2009~ (2009)
- Fumino S, "Bleeding tendency as a first symptom in children with congenital biliary dilatation", Eur J Pediatr Surg, 17, pp.2~5 (2007)
- Riederer J, "Obstructive jaundice du to sludge in the common bile duct", Dtsch Med Wochenschr, 125, pp.11~14 (2000)
- Senturk S, "Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT", Eur J Radiol, 81, pp.39~42 (2012)
- Landry D, "Dilatation of the bile duct in patients after cholecystectomy: a retrospective study", Can Assoc Radiol J, 65, pp.29~34 (2014)
- Daradkeh S, "Factors affecting common bile duct diameter", Hepatogastroenterology, 52, pp.1659~1661 (2005)
- Lee HC, "Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance", J Ultrasound Med, 19, pp.177~182 (2000)
- Kim JE, "The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography", Endoscopy, 33, pp.495~500 (2001)