Biliary Tract Diseases: The Common and the Uncommon
This session discussed two complex pediatric biliary cases presented by surgical trainees and faculty. The first case involved a 6-month-old patient with obstructive jaundice and pancreatitis, ultimately diagnosed with a rare choledochocoleal cyst type 3A, which was successfully treated via transduodenal sphincteroplasty. The second case presented a 15-year-old obese patient with obstructive jaundice secondary to cholelithiasis, who underwent a laparoscopic cholecystectomy with transcystic common bile duct exploration using a Fogarty balloon catheter technique. The discussion highlighted the challenges of managing rare biliary anomalies in children and the debate between surgery-first versus ERCP-first approaches, with considerations for center-specific capabilities and communication with adult hepatobiliary colleagues.
Complete Video, Both Cases
Case 1. Patient 6 Months Old with Liver Enzyme Abnormalities
A 6-month-old patient with elevated liver enzymes, vomiting, and white-gray stools, presenting with direct hyperbilirubinemia and pancreatitis markers. The surgical team considered differential diagnoses, including biliary anomalies, stones, and infection, with lab results showing elevated bilirubin, ALP, GGT, and lipase. The team agreed to investigate further with an ultrasound to assess for obstructive causes. (Case Takeaways)
Case 2. Gallstone Disease in Teenager
A case was presented of a 15-year-old male with right upper quadrant abdominal pain, nausea, vomiting, and subjective jaundice, likely because of gallstones and gallbladder disease. The patient's labs showed elevated liver function tests and a normal lipase, while ultrasound revealed a distended gallbladder with mobile sludge, stones, and mild pericoloccystic fat. Urban discussed the increasing prevalence of gallstone disease in obese teenagers and the decision to treat with antibiotics due to the patient's tender abdomen and common bile duct dilation. The group discussed whether additional imaging, such as MRCP, or interventional procedures before surgery would be necessary for this patient, emphasizing the importance of access to reliable ERCP services. (Case Takeaways)