Duct In Children Research Articles

Minilaparotomy for cystic transformations of bile ducts in children

Aim. To improve treatment outcomes for children with common bile duct cysts. Materials and methods. The study enrolled children with common bile duct cysts (n = 84) examined from January 2010 to November 2023. All patients underwent cyst excision, Roux-en-Y hepaticojejunostomy laparoscopically or from a minilaparatomy access. A comparative analysis of the treatment outcomes was carried out to select the optimal access. The timing of surgery, as well as early and late postoperative complications were analyzed. Results. The timing of surgery from the minilaparotomy access was shorter. Defecation in children of the minilaparotomy subgroup appeared 3 times earlier than in children after laparoscopic hepaticojejunostomy, largely due to earlier enteral load. A good treatment outcome was observed in 92 % of patients who underwent intervention from a minilaparotomy access compared to 52.2 % of patients who underwent laparoscopic surgery. Conclusion. Currently, laparoscopic access is a non-optimal method for treatment of children with common bile duct cysts. Minilaparotomy appears to be a promising surgical access in children and may be proposed as a standard for common bile duct cysts.

Endoscopic pancreatic interventions in children

Aim. To increase the efficiency of surgical treatment for children with pancreatic malformations and diseases using endoscopic interventions. Materials and methods. The study enrolled 39 children aged 3–17 years who underwent 58 endoscopic interventions. Results. Transpapillary interventions were performed in 14 children with pancreatic duct abnormalities. Stenosis of the proximal pancreatic ducts was revealed in 5 observations – stenting was performed. Lithiasis of Wirsung's duct was confirmed in 4 observations, an abnormality in the form of an incomplete pancreas divisum was revealed in 3 of them. Pancreas divisum was detected in 1 patient, sphincterotomy of the minor duodenal papilla was performed. Transmural interventions were carried out in 24 observations: puncture – in 10 patients with intra- or parapancreatic cystic formations, drainage – in 14 patients with pseudocysts. Combined transpapillary and transmural surgery was performed in a child with traumatic pancreatic disruption. Conclusion. Transpapillary interventions prove to effectively eliminate hypertension in the pancreatic ducts in children. Transmural procedures can be used to drain pancreatic pseudocysts in children.

Diseases of bile duct in children.

Several diseases originate from bile duct pathology. Despite studies on these diseases, certain etiologies of some of them still cannot be concluded. The most common disease of the bile duct in newborns is biliary atresia, whose prognosis varies according to the age of surgical correction. Other diseases such as Alagille syndrome, inspissated bile duct syndrome, and choledochal cysts are also time-sensitive because they can cause severe liver damage due to obstruction. The majority of these diseases present with cholestatic jaundice in the newborn or infant period, which is quite difficult to differentiate regarding clinical acumen and initial investigations. Intraoperative cholangiography is potentially necessary to make an accurate diagnosis, and further treatment will be performed synchronously or planned as findings suggest. This article provides a concise review of bile duct diseases, with interesting cases.

Does CISS MRI Reliably Depict the Endolymphatic Duct in Children with and without Vestibular Aqueduct Enlargement?

High-resolution CT is the mainstay for diagnosing an enlarged vestibular aqueduct (EVA), but MR imaging may be an appealing alternative, given its lack of ionizing radiation exposure. The purpose of this study was to determine how reliably MR imaging demonstrates the endolymphatic duct and endolymphatic duct enlargement in hearing-impaired children. We performed a retrospective review of temporal bone high-resolution CT and MR imaging of hearing-impaired children evaluated between 2017 and 2020. Vestibular aqueduct diameter was measured on high-resolution CT. The vestibular aqueducts were categorized as being enlarged (EVA+) or nonenlarged (EVA-) using the Cincinnati criteria. The endolymphatic ducts were assessed on axial high-resolution CISS MR imaging. We categorized endolymphatic duct visibility into the following: type 1 (not visible), type 2 (faintly visible), and type 3 (easily visible). Mixed-effect logistic regression was used to identify associations between endolymphatic duct visibility and EVA. Interreader agreement for the endolymphatic duct among 3 independent readers was assessed using the Fleiss κ statistic. In 196 ears from 98 children, endolymphatic duct visibility on MR imaging was type 1 in 74.0%, type 2 in 14.8%, and type 3 in 11.2%; 20.4% of ears were EVA+ on high-resolution CT. There was a significant association between EVA+ status and endolymphatic duct visibility (P < .01). Endolymphatic duct visibility was type 1 in 87.1%, type 2 in 12.8%, and type 3 in 0% of EVA- ears and type 1 in 22.5%, type 2 in 22.5%, and type 3 in 55.0% of EVA+ ears. The predicted probability of a type 3 endolymphatic duct being EVA+ was 0.997. There was almost perfect agreement among the 3 readers for distinguishing type 3 from type 1 or 2 endolymphatic ducts. CISS MR imaging substantially underdiagnoses EVA; however, when a type 3 endolymphatic duct is evident, there is a >99% likelihood of an EVA.

Percutaneous transhepatic cholangiostomy in children

Introduction. Congenital malformations of the bile ducts, complicated course of cholelithiasis, strictures of biliodigestive anastomoses, tumors of the pancreatobiliary zone can lead to mechanical jaundice. It is not always possible to perform unloading cholecystostomy for the urgent bile derivation, to stent bile ducts with retrograde endoscopy; more so, to perform radical surgery under hyperbilirubinemia is a risky intervention that can cause complications. Then, percutaneous transhepatic cholangiostomy becomes a method of choice. We present our own experience of interventional surgical procedures on the biliary ducts in children with biliary obstruction.&#x0D; Material and methods. 14 patients, aged 6–17 years , who had 47 interventions were included in the study.&#x0D; Results. In all cases, percutaneous transhepatic cholangiostomy was successful and stopped biliary hypertension. Stricture recanalization after balloon dilation was successful in 4 patients with hepaticoejunoanastomosis stenosis. Puncture neoanastomosis of the disconnected posterior-sectorial duct was performed in 2 patients. External drainage of the bile ducts with subsequent radical treatment was performed in 10 patients; the “Rendez-vous” technique - in 1 patient.&#x0D; Conclusion. Interventional surgical procedures on the bile ducts in children is an effective method of treatment in various clinical situations leading to mechanical jaundice. In some cases, it can effectively stop biliary hypertension. And such methods as recanalization of strictures and puncture neoanastomosis can be a final minimally invasive technique for treating disorders of bile outflow.

Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children

Introduction: Endoscopic procedures are performed more frequently in children due to technological advances that can be safely performed in an adequate setting with a support of a multidisciplinary team. Pediatric indications for ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound) occur mainly due to congenital malformations. In a pediatric case series, we report the application of EUS combined with duodenoscopy, eventually associated with ERCP and minimally invasive surgery, highlighting the importance of defining a tailored dedicated management pathway for each patient. Patients and methods: A series of 12 patients, managed at our Center in the last three years, were evaluated, and their management was discussed. Results: EUS was performed in eight patients and permitted the differential diagnosis of duplication cysts and the visualization of the biliary tree and pancreatic anatomy. ERCP was attempted in five patients: in one case, it permitted the preservation of pancreatic tissue, postponing surgery and in three patients, it was technically unfeasible. MIS (minimally invasive surgery) was performed in seven patients, two with laparoscopic common bile duct exploration (LCBDE). Precise anatomical definition and the possibility of surgical simulation and team sharing were evaluated under VR HMD (Virtual Reality Head Mounted Display) in four cases. Conclusions: Exploration of the common bile duct in children differs from that of the adult population and combines echo-endoscopy and ERCP. The integrated use of minimally invasive surgery in the pediatric area is necessary for the whole management perspective in complex malformations and small patients. The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.

Magnetic Resonance Cholangiopancreatography vs Endoscopy Retrograde Cholangiopancreatography for Detection of Anatomic Variants of the Pancreatic Duct in Children

To compare the efficacy of magnetic resonance cholangiopancreatography (MRCP) with endoscopy retrograde cholangiopancreatography (ERCP) in children for the identification of pancreatic duct variants. We identified children with a pancreatic duct variant by ERCP and separately queried our MRCP database for similar variants. Patients with a paired ERCP-MRCP were reviewed. Three radiologists blinded to the ERCP and MRCP findings were asked to independently review the MRCP studies and define the pancreatic duct anatomy. These blinded reviewers also graded the magnetic resonance imaging examination quality. Seventy-four pairs of ERCP-MRCP examinations were identified. Pancreas divisum was the most frequent ductal variant encountered (73%). There was fair agreement between the radiology reviewers as to the quality of the magnetic resonance imaging studies (Fleiss Kappa agreement). Concordance of the reviewers with that of the ERCP was moderate for the exact diagnosis, moderate for the presence of pancreas divisum, and fair for agreement on the presence of any duct variant. Concordance among reviewers was moderate for the exact diagnosis, moderate for normal vs abnormal, and substantial for the presence of pancreas divisum. Diagnostic limitations exist when comparing MRCP with the gold reference standard of ERCP, specifically when assessing for pancreatic duct variants in children.

Ultrasound Еxamination of the Еxtrahepatic Bile Ducts in Children (Literature Review with our own Clinical Observations)

To study the normal sonographic anatomy of extrahepatic bile ducts, a polypositional ultrasound examination of 120 children aged 0 to 17 years was conducted. The technique of hepatoduodenal ligament ultrasound examination is described. The main sonographic visual indicators for studying the anatomical and topographic structure of extrahepatic bile ducts in children are denoted. The normative parameters of the common bile and common hepatic ducts in children of different age groups are presented.

Primäre Rekonstruktion der ableitenden Tränenwege nach Trauma – bikanalikulonasale Schienung mit autostabilen Silikonverweilsonden

Trauma of the medial canthal region can affect all parts of the lacrimal ducts. Depending on the patient's age, there may be different mechanisms of injury. Surgical reconstruction using two autostable ("self-retaining") monocanaliculonasal lacrimal tubes is demonstrated by two case reports. Here, a 6 years old girl attacked by a dog (Rottweiler) showed severe periocular soft tissue damage with deep involvement of the lacrimal ducts. The child's inferior canaliculus was lacerated. Furthermore, the common canaliculus was dissected from the lacrimal sac. Deep soft tissue damage consisted of blunt and sharp injuries down to the cheek and nose. After lacrimal intubation with two autostable monocanaliculonasal tubes, the soft tissue was reconstructed by direct canalicular suturing and stepwise closure of each layer. One of the lacrimal tubes was fixated at the lid by additional sutures, in order to avoid stent prolapse. Beside slight medial depression of inferior lid, there were no signs of functional disturbance of the lacrimal ducts. The follow-up was 18 months. The second case report presents a 43 years old man. He accidentally cut himself with a butcher's knife. He suffered a deep wound of his medial canthal region. The patient presented with proximal (located near the lacrimal sac) laceration of both canaliculi. The medial canthal ligament as well as the orbicularis muscle had been cut. Using two autostable monocanaliculonasal lacrimal tubes, the lacrimal ducts were stented and reconstructed with sutures. During the follow-up of 6 months, no epiphora or mucopurulent lacrimal discharge occurred. In lacrimal trauma, different parts of the lacrimal ducts may be affected at the same time. Identification of the injured structures with respect to the kind of injury, localisation and the extent of damage is crucial. Stepwise wound closure in respect to the topographic anatomy is mandatory. Here, lid and lacrimal ducts must be respected as one functional unit. Simultaneous use of autostable monocanaliculonasal lacrimal tubes in both canaliculi can be applied for trauma reconstruction of the lacrimal ducts in children and adults.

Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.

Опыт хирургического лечения дакриостенозов у детей: результаты и осложнения

Currently, there is a high interest of health care professionals in the treatment of childhood dacryostenosis. The problem of dacryostenosis is at the intersection of ophthalmology and rhinology. However, more often patients seek eye care due to the fact that the leading complaints are lacrimation and purulent discharge from the eye. Analysis of the literature shows the absence of consensus on the methods of surgical treatment, materials and the timing of the stent in the lacrimal ducts. Purpose . Analysis of the first 30 cases of surgical treatment for dacryostenosis in children performed in the Department of ophthalmology of the Сhildren’s Clinical Hospital in Kazan. Material and methods . Analysis of surgical treatment for dacryostenosis in 30 children aged from 11 months to 8 years 10 months. To restore patency of the tear ducts, we applied the method of S.F. Shkolnik proposed in 2009 with some of our modifications in terms of tools and materials for intubation. Results . In most children, the disease began at birth. Prior to surgical treatment, they had from 0 to 4 soundings of the tear ducts. In the vast majority of cases, dacryostenosis was single-level and associated with congenital anomalies. There were post-traumatic changes in 2 cases. The complications included 2 cases of recurrence of dacryostenosis associated with insufficient stent in the lacrimal ducts and 2 cases of corneal erosion. Conclusion . In our opinion, it is optimal to find a stent in the lacrimal ducts in children for a month. However, the method of surgical treatment for dacryostenosis in children requires further study and standardization.

Secretin Improves Visualization of Nondilated Pancreatic Ducts in Children Undergoing MRCP.

OBJECTIVE. The objective of our study was to assess whether secretin improves visualization of a nondilated pancreatic duct and whether it increases identification of variant duct anatomy on MRCP in pediatric patients. MATERIALS AND METHODS. This study is a delayed retrospective review of MRCP images that were prospectively obtained of 50 volunteers without a history of pancreatic disease who ranged in age from 6 to 15 years old. MRCP images (coronal 3D fast recovery fast spin-echo [FSE] and coronal single-shot FSE fat-saturated sequences) obtained before and after secretin administration were separated for review by three radiologists (reviewers 1-3). The reviewers were blinded to the purpose of the study and to secretin administration. Reviewers ranked subjective image quality (Likert scale, 1-5 points) and reported pancreaticobiliary duct anatomy and duct visibility (yes or no). Paired t tests were used for comparison of means, and the chi-square test or Fisher exact test was used for comparison of frequencies. Sensitivity and specificity of MRCP images obtained before secretin administration were judged against MRCP images obtained after secretin administration as the reference standard. RESULTS. The frequency of image quality scores of 4 or greater assigned to 3D MRCP images was statistically significantly greater after secretin administration for reviewer 2 (p < 0.0001) and reviewer 3 (p = 0.005) and approached statistical significance for reviewer 1 (p = 0.052). Mean number of visible pancreatic duct segments (head and uncinate, body, tail) was significantly greater on the MRCP images obtained after secretin administration than on those obtained before secretin administration for all reviewers (reviewer 1, 1.9 vs 1.3; reviewer 2, 1.9 vs 1.2; reviewer 3, 1.4 vs 0.8; all, p < 0.01). For all three reviewers, the sensitivity of MRCP images obtained before secretin administration was poor for variant pancreatic ductal anatomy (reviewer 1, 37.5%; reviewer 2, 50.0%; reviewer 3, 40.0%). CONCLUSION. Secretin administration improved subjective MRCP image quality, improved subjective visualization of the pancreatic duct, and provided greater sensitivity for anatomic variants such as pancreas divisum in a cohort of children with nondilated pancreatic ducts.

Non Syndromic Paucity of Interlobular Bile Ducts in Children – A Clinicopathological Study

Background: Non syndromic paucity of interlobular bile ducts (NS-PILBD) constitutes a miniscule of infantile cholestasis. Method: Clinical details, investigations, surgical findings, management and outcome of cases of NS-PILBD at liver biopsy were analyzed. Specific histopathological features including bile duct to portal tract ratio were studied. Results: Eighteen cases (1993–2013) are detailed. Clinical presentation and investigations were similar to biliary atresia. Hepatic scintigraphy showed no gut excretion in 13/18 and operative cholangiogram was normal in all. Liver biopsy showed a median Scheuer fibrosis stage of 2, the mean bile duct/portal tract ratio was 0.29. The average age at last follow up of twelve cases was 54.9 months . Ten were asymptomatic and anicteric, the liver function tests had normalized over 3–15 months. Conclusion: Histopathology differentiated NS-PILBD from other causes of infantile cholestasis .The idiopathic form generally had a favorable long term outcome with medical management.

Disconnected Pancreatic Duct in Children With Walled OFF Necrosis: Impact on Outcomes of Endoscopic Drainage.

Disconnected pancreatic duct syndrome (DPDS) is frequently encountered in cases with walled off necrosis (WON). The impact of DPDS on the outcomes of pancreatic fluid collections (PFCs) is not well known. In this study, we aim to evaluate the incidence of DPDS and its clinical impact on the outcomes of endoscopic ultrasound (EUS)-guided drainage of PFC in children. All children with symptomatic WON who underwent EUS-guided drainage using metal stents were included in the study. At 4 weeks, pancreatic ductal anatomy was evaluated, and metal stents removed. All the children were followed at regular intervals and evaluated for the recurrence of PFC and the development of new-onset diabetes. A total of 32 children (28 boys, median age 15 years) underwent EUS-guided drainage of WON. Resolution of WON was documented in all children at 4 weeks. Pancreatic ductal anatomy using magnetic resonance retrograde cholangiopancreatography and endoscopic retrograde pancreatography was available in 30 (93.7%) children. Of these, DPDS was documented in 25 (83.3%) children including proximal disconnection in 12 and distal disconnection in 13 children. Recurrent PFC and new-onset diabetes were found in 5 (20%) and 2 (8%) children with DPDS, respectively. Of the 5 recurrences of PFC, endoscopic reintervention was required in 3 children. Majority of the children with DPDS do not develop a symptomatic recurrence of PFC after the removal of cystogastric stents. DPDS may be a risk factor for the development of new-onset diabetes. However, future prospective studies are needed.

Laparoscopic management for aberrant hepatic duct in children with choledochal cysts.

The aim of the current study is to evaluate efficacy of laparoscopic treatment for aberrant hepatic duct (AHD) in children with cholecochal cysts (CDC). CDC children with AHDs who successfully underwent laparoscopic ductoplasties and hepaticojejunostomies between October 2001 and October 2017 were reviewed. The AHD variations were categorized into four subtypes and the surgical management varied according the subtypes. Sixty CDC patients with AHDs were reviewed. The mean age at surgery was 3.91years. Two patients with Type 2 anomaly developed bile leaks after primary surgeries, and underwent laparoscopic anastomosis of AHD to jejunum in redo surgeries. In the remaining 58 patients, the average operative time was 3.75h. The mean postoperative hospital stay was 6.02days. The mean duration for full diet resumption was 2.25days. The mean drainage time was 4.05days. The median follow-up period was 30months. Two patients with giant cysts had fluid collections, and were cured by drainages. One patient encountered duodenal injury at perforation site, and underwent laparoscopic repair. None of the patients had anastomotic stenosis, bile leak, cholangitis, intrahepatic reflux, pancreatic leak, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction. Postoperative liver function tests and serum amylase level normalized within 1year. Recognition and treatment based on different subtypes of AHDs effectively prevent relevant complications. Individualized laparoscopic ductoplasty and hepaticojejunostomy is an efficacious management for AHDs in CDC children.

Associated patent urachus and patent omphalo–mesenteric duct in children

The objective of this article is to review the literature on a very rare association such as patent urachus and a patent omphalo–mesenteric duct in children. Partial or total failure of the obliteration of urachus gives rise to various anomalies, which can be diagnosed both in childhood and in adulthood. The omphalo–mesenteric duct remnants are the most common anomalies of the gastro-intestinal tract, often asymptomatic. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare. A computer-assisted (PubMed and Google Scholar) search of the pediatric literature to identify all cases of patent urachus and a patent omphalo–mesenteric duct association was performed. We found only eleven cases of the association of patent urachus and a patent omphalo– mesenteric duct in the pediatric literature. All cases except one were males. When reported, all children affected were full term. The clinical sign reported was umbilical spillage. In all cases was reported a lack of healing of the umbilical stump with different clinical pictures, except two cases. Treatments reported were application of silver nitrate, antibiotic cream, povidone iodine, and application of salves and plasters. Various diagnostic examinations were performed. In none of these patients was the possible association with PU and POMD suspected, but it was evidenced only during the surgical excision. The surgical approach was laparotomy in all cases. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare approached in all cases by laparotomy. This review underlines the importance of evaluating any persisting umbilical lesions without delay when conventional pharmacological therapy fails. Keywords: omphalo–mesenteric duct, patent omphalo–mesenteric duct, patent urachus, remnants, urachus

PREOPERATIVE AND INTRAOPERATIVE RISKS OF ERRORS IN CYSTS SURGERY OF THE BILE DUCTS IN CHILDREN

OBJECTIVE. The study analyzed preoperative errors and intraoperative risks in cystic transformations of the bile duct in children. MATERIALS AND METHODS. The data of 76 patients with cystic transformations of the bile duct were evaluated. Various operations were performed on 74 (97,4 %) patients. RESULTS. There were noted different complications in 34 cases on the stage of diagnostics and surgical treatment. The iatrogenic complications were observed in patients with complex anatomical and topographic anomalies. The article presents the most frequent complications, their causes and features of treatment approach. CONCLUSIONS. Diagnostic and tactical errors were made due to low awareness of doctors regarding cystic transformations of the bile duct and lack of clear symptoms of dynamic characteristics of clinical signs of the defect. Risk of intraoperative complications would be increased because of earlier performed an erroneous or inadequate surgery and expressed inflammatory process of hepatoduodenal area.

Mistakes, dangers and complications in surgery of the cysts of biliary ducts in children

Mistakes, dangers and complications in surgery of the cysts of biliary ducts in children

Features of clinical picture of cystic dilatations of the biliary ducts in children

Features of clinical picture of cystic dilatations of the biliary ducts in children

Anatomic anomalies of pancreatic duct in children with chronic pancreatitis

Choledochal cyst (CC) is closely associated with anomalous arrangement of the pancreaticobiliary duct, which is considered a high-risk factor for biliary tract malignancy. Early diagnosis and early treatment for CC could lead to a good prognosis. This study investigated late complications and long-term outcomes after surgery for CC.Fifty-six patients with CC and over 10 years of postoperative follow-up were analyzed retrospectively. All patients had undergone total resection of the extrahepatic bile duct and hepaticojejunostomy.Six patients showed liver dysfunction manifested in the first 10 years after surgery, but all returned to normal thereafter. Dilatation of intrahepatic bile ducts persisted in 6 postoperatively, and in 3, this was still apparent more than 10 years after. Recurrent abdominal pain was encountered in 3, 1 had pancreas divisum with a pancreatic stone, and 1 had adhesive small bowel obstruction. Two patients developed biliary tract malignancy. A 14-year-old girl died of recurrent common bile duct cancer 2 years after the initial resection of CC with adenocarcinoma. A 26-year-old man with repeated cholangitis owing to multiple intrahepatic bile stones developed cholangiocarcinoma 26 years after the initial resection of CC. Event-free survival rate and overall survival rate were 89% (50/56) and 96% (54/56), respectively.Choledochal cyst generally has an excellent prognosis with early total resection and reconstruction. Long-term surveillance for the development of malignancy is still essential, especially if there is ongoing dilatation of the intrahepatic bile duct or biliary stones.