Ultrasound Guided Percutaneous Cholecystocholangiography for Early Differentiation of Cholestatic Liver Disease in Infants

Abstract

SummaryDirect visualization of the extrahepatie biliary tree is difficult in infants and young children without resorting to an intraoperative cholangiogrum. Small size and lack of dilated intrahepatic ducts especially in infants with cholestatic jaundice often preclude using the techniques of percutaneous transhcpatic cholangiography or endoscopic retrograde cholangiopancreatography. We studied the feasibility of ultrasound‐guided percutaneous Cholecystocholangiography (US‐guided PCC) in differentiating extrahepatie from intrahepatic causes of cholestatic jaundice in four infants. Clinical, laboratory, radiographic, and histologic criteria had not conclusively excluded extrahepatie obstruction prior to the use of this technique. Four infants, between 4 and 10 weeks of age. were studied without complications. In one patient, biliary atresia was diagnosed at 4 weeks of age; in another, aspirated bile was cultured leading to a specific diagnosis of bacterial cholangitis; and, in two others, intrahepatic cholestasis was confirmed by the demonstrated patency of the extrahepatie biliary tree. In infants and young children in whom a gallbladder lumen can be seen, US‐guided PCC offers a potential rapid, nonoperative means of differentiating intrahepatic and extrahepatie causes of cholestatic jaundice, defining the anatomy of the extrahepatie biliary tree, and directly sampling gallbladder bile.