Overview
The monthly Surgery-Radiology-Pathology Rounds discussed hepatobiliary cases in children, with participants sharing their experiences and perspectives on different presentations and treatments. The session focused on the pathologic analysis of two cases involving biliary duct structures in children. The first case involved a 12-yr-old female with fibrous changes and chronic inflammation, while the second case was more complex, showing biliary duct obstruction and cholestasis. The pathologists discussed the morphological features, surgical margins, and potential causes of the observed changes, noting that the inflammation in the first case was interesting given the patient's asymptomatic history. The session ended with a discussion about reporting practices, particularly regarding the degree of inflammation and muscle presence in resection margins, with some uncertainty about whether these factors are still relevant in current reporting guidelines.
Case reviews focused on the management of a 12-yr-old patient with a type 1 choledochal cyst who initially presented with intermittent pruritus and was conservatively managed before eventually undergoing surgical intervention. The team discussed various aspects of surgical procedures for choledochal cysts, including the technical challenges of laparoscopic operations and the importance of proper identification and transection of ducts during surgery. The group also explored diagnostic considerations and imaging techniques used in these cases, emphasizing the need for vigilance in monitoring patients with asymptomatic lesions and the rarity of celiac disease in patients with choledochal cysts.
Case 2. Neonatal Case of a 9-Wk-Old Boy with Seizures and Abdominal Symptoms
Case 2 discussed a neonatal case involving a 9-wk-old boy with seizures and abdominal symptoms, leading to the consideration of biliary pathologies and the review of prenatal ultrasound findings. There was a neonatal biliary obstruction due to a choledochal cyst, which was successfully treated with open surgery and confirmed through post-operative imaging. The discussion concluded with a pathologic analysis of two cases involving biliary duct structures in children, focusing on morphological features and surgical margins, along with a discussion about current reporting practices.