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Ultrasonography and percutaneous cholangiography in children with dilated bile ducts
ABSTRACTS
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had been present for 25 yr. This risk is greater if the left colon is retained. Epithelial dysplasia of the colon and rectum as an additional factor in the development of carcinoma is also discussed. The authors conclude that there is a trend toward the development of cancer in the colons of patients who have dysplasia. These patients should not have an IRA performed. The authors further recommend careful follow-up, including frequent rectal biopsies in patients who have had ulcerative colitis for more than 10 yr. If dysplastic changes persist in patients who have undergone an IRA, proctectomy should be done.--Jane F. Goldthorn ABDOMEN Pneumoperitoneum in Infants Without Gastrointestinal Perforation. J. T. Zerella and J. Y. McCullough. Surgery
89:163-167, (February), 1981. Pneumoperitoneum in 10 infants with respiratory distress without gastrointestinal perforations prompted this report. All patients were less than 2200 g; most less than 1500 g. All but one was being ventilated at the time of pneumoperitoneum; all had either/or interstitial emphysema, pneumothorax, pneumomediastinum, or pneumopericardium prior to pneumoperitoneum. Lack of prodromal abdominal distension, intestinal air-fluid levels, bowel wall edema, and pneumatosis suggested "medical" pneumoperitoneum. In order to exclude "surgical" pneumoperitoneum paracenteses were performed; fluid should either be nonobtainable or clear, without bile or feces, elevated amylase or bacteria. Water soluble contrast medium is instilled into the stomach and serial x-rays obtained, searching for extravasation of dye. All 10 patients were managed without laparotomy. Three survived and subsequently showed no evidence of gastrointestinal disease. In five of seven who died, autopsies were performed and revealed no evidence of gastrointestinal perforation. The authors conclude that unnecessary laparotomies can be avoided in these critically ill neonates.--Eugene S. Wiener Surgical Anatomy of the Hepatic Veins and the Inferior Vena Cava. S. Nakamura and 7". Tsuzuki. Surg Gynecol
Obstet 152:43-50, (January), 198 I. Material from 83 autopsies was examined concerning the patterns of the hepatic veins along with right suprarenal and inferior phrenic veins, as well as length of the various segments of the inferior vena cava. A detailed study is presented and this information is indispensable for surgeons who perform extensive hepatic resection, transplantation, and treatment of hepatic trauma.--George Holcomb, Jr. Pathogenesis of Infantile Obstructive Cholangiopathy: An Experimental Study. T. Ogawa. J Jpn Soc Pediatr Surg
16:1151-1161, (December), 1980. Inflammation of the hepatobiliary system was induced in Wistar-rats by administration of 1,4-phenylenediisothiocyanate (PDT). Twenty-two rats, receiving PDT during late fetal period, showed only thickening and fibrosis of the extrahepatic bile ducts without any dilatation, whereas 10 rats, receiving PDT during the fetal period and 30 days after birth, showed stenosis or obstruction of the extrahepatic bile
ducts due to progressive fibrosis and thickening of the ductal wall. This experimental study suggests that different manifestations of infantile obstructive cholangiopathy are the result of various developmental stages of the same pathologic process.--H. Suzuki Ultrasonography and Percutaneous Cholangiography in Children With Dilated Bile Ducts. P. Douillet, F. Brunelle,
P. Chaumont, J. Va/ayer, C. Sassoon, and M. Odievre. Am J Dis Child 135(2):131-133, 1981. Six children had dilation of intrahepatic and extrahepatic bile ducts. The dilation was associated with or was secondary to lithiasis in two patients, spontaneous bi/e duct perforation in two others, and an abnormal pancreaticobiliary junction in the last two. All six patients were screened by ultrasonography; five were subsequently examined by percutaneous transhepatic cholangiography. Ultrasonography rapidly identified bile duct dilation, while percutaneous cholangiography was valuable in choosing the correct surgical procedure by locating the site of obstruction. A single episode of postcholangiography cholangitis occurred, suggesting that this study would be more safely performed immediately prior to surgery.--J. J. Tepas Use of Gamma-Glutamyl Transpeptidasa in the Diagnosis of Biliary Atresia. K. Wright and D. L. Christie. Am J Dis
Child 135:134-136, (February), 1981. To determine the diagnostic usefulness of 3,-glutamyl transpeptidase (GGTP) in differentiating biliary atresia (BA) from neonatal hepatitis (NH), serum levels were measured prospectively in 17 infants (aged 5-16 wk) admitted consecutively to rule out BA. Seven patients were found to have BA, seven had NH, and three had a antitrypsin (AA) deficiency. The mean maximal GGTP level in those patients with NH (183 -+ 54 IU/liter) was significantly lower than that found in patients with BA (760 _+ 492 IU/liter) or AA deficiency (1725 +_ 21 IU/liter). In the 14 patients without AA deficiency, a serum GGTP level greater than 300 I U / L correctly identified symptoms of seven patients with BA while a GGTP level less than 300 IU/liter correctly identified seven of seven patients with NH, although including one false negative finding in a patient with a choledochal cyst and BA.--J. J. Tepas Prognostic Determinants After Hepatoportoenterostomy for Biliary Atresia. T. R. Weber, J. L. Grosfeld, and J. F.
Fitzgerald. Am J Surg 141:57-60, (January), 1981. Between 1976 and 1979, 17 patients who had undergone hepatoportoenterostomy by the Suruga or Sawaguchi techniques had secretory studies done to determine prognosis. Bilirubin and alkaline phosphatase clearances, secreted bilirubin measurements, and rose bengal scans were done. Ten children survived the disease to date. They had significantly higher bilirubin and alkaline phosphatase clearances and secreted bilirubins beginning 1 mo postoperatively than nonsurvivors. Six of the 10 survivors had improved secretory function after reoperation. Four required higher transection of ducts and two improved after relief of Roux-en-Y biliary loop obstruction. The exact criteria for reoperation are not
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had been present for 25 yr. This risk is greater if the left colon is retained. Epithelial dysplasia of the colon and rectum as an additional factor in the development of carcinoma is also discussed. The authors conclude that there is a trend toward the development of cancer in the colons of patients who have dysplasia. These patients should not have an IRA performed. The authors further recommend careful follow-up, including frequent rectal biopsies in patients who have had ulcerative colitis for more than 10 yr. If dysplastic changes persist in patients who have undergone an IRA, proctectomy should be done.--Jane F. Goldthorn ABDOMEN Pneumoperitoneum in Infants Without Gastrointestinal Perforation. J. T. Zerella and J. Y. McCullough. Surgery
89:163-167, (February), 1981. Pneumoperitoneum in 10 infants with respiratory distress without gastrointestinal perforations prompted this report. All patients were less than 2200 g; most less than 1500 g. All but one was being ventilated at the time of pneumoperitoneum; all had either/or interstitial emphysema, pneumothorax, pneumomediastinum, or pneumopericardium prior to pneumoperitoneum. Lack of prodromal abdominal distension, intestinal air-fluid levels, bowel wall edema, and pneumatosis suggested "medical" pneumoperitoneum. In order to exclude "surgical" pneumoperitoneum paracenteses were performed; fluid should either be nonobtainable or clear, without bile or feces, elevated amylase or bacteria. Water soluble contrast medium is instilled into the stomach and serial x-rays obtained, searching for extravasation of dye. All 10 patients were managed without laparotomy. Three survived and subsequently showed no evidence of gastrointestinal disease. In five of seven who died, autopsies were performed and revealed no evidence of gastrointestinal perforation. The authors conclude that unnecessary laparotomies can be avoided in these critically ill neonates.--Eugene S. Wiener Surgical Anatomy of the Hepatic Veins and the Inferior Vena Cava. S. Nakamura and 7". Tsuzuki. Surg Gynecol
Obstet 152:43-50, (January), 198 I. Material from 83 autopsies was examined concerning the patterns of the hepatic veins along with right suprarenal and inferior phrenic veins, as well as length of the various segments of the inferior vena cava. A detailed study is presented and this information is indispensable for surgeons who perform extensive hepatic resection, transplantation, and treatment of hepatic trauma.--George Holcomb, Jr. Pathogenesis of Infantile Obstructive Cholangiopathy: An Experimental Study. T. Ogawa. J Jpn Soc Pediatr Surg
16:1151-1161, (December), 1980. Inflammation of the hepatobiliary system was induced in Wistar-rats by administration of 1,4-phenylenediisothiocyanate (PDT). Twenty-two rats, receiving PDT during late fetal period, showed only thickening and fibrosis of the extrahepatic bile ducts without any dilatation, whereas 10 rats, receiving PDT during the fetal period and 30 days after birth, showed stenosis or obstruction of the extrahepatic bile
ducts due to progressive fibrosis and thickening of the ductal wall. This experimental study suggests that different manifestations of infantile obstructive cholangiopathy are the result of various developmental stages of the same pathologic process.--H. Suzuki Ultrasonography and Percutaneous Cholangiography in Children With Dilated Bile Ducts. P. Douillet, F. Brunelle,
P. Chaumont, J. Va/ayer, C. Sassoon, and M. Odievre. Am J Dis Child 135(2):131-133, 1981. Six children had dilation of intrahepatic and extrahepatic bile ducts. The dilation was associated with or was secondary to lithiasis in two patients, spontaneous bi/e duct perforation in two others, and an abnormal pancreaticobiliary junction in the last two. All six patients were screened by ultrasonography; five were subsequently examined by percutaneous transhepatic cholangiography. Ultrasonography rapidly identified bile duct dilation, while percutaneous cholangiography was valuable in choosing the correct surgical procedure by locating the site of obstruction. A single episode of postcholangiography cholangitis occurred, suggesting that this study would be more safely performed immediately prior to surgery.--J. J. Tepas Use of Gamma-Glutamyl Transpeptidasa in the Diagnosis of Biliary Atresia. K. Wright and D. L. Christie. Am J Dis
Child 135:134-136, (February), 1981. To determine the diagnostic usefulness of 3,-glutamyl transpeptidase (GGTP) in differentiating biliary atresia (BA) from neonatal hepatitis (NH), serum levels were measured prospectively in 17 infants (aged 5-16 wk) admitted consecutively to rule out BA. Seven patients were found to have BA, seven had NH, and three had a antitrypsin (AA) deficiency. The mean maximal GGTP level in those patients with NH (183 -+ 54 IU/liter) was significantly lower than that found in patients with BA (760 _+ 492 IU/liter) or AA deficiency (1725 +_ 21 IU/liter). In the 14 patients without AA deficiency, a serum GGTP level greater than 300 I U / L correctly identified symptoms of seven patients with BA while a GGTP level less than 300 IU/liter correctly identified seven of seven patients with NH, although including one false negative finding in a patient with a choledochal cyst and BA.--J. J. Tepas Prognostic Determinants After Hepatoportoenterostomy for Biliary Atresia. T. R. Weber, J. L. Grosfeld, and J. F.
Fitzgerald. Am J Surg 141:57-60, (January), 1981. Between 1976 and 1979, 17 patients who had undergone hepatoportoenterostomy by the Suruga or Sawaguchi techniques had secretory studies done to determine prognosis. Bilirubin and alkaline phosphatase clearances, secreted bilirubin measurements, and rose bengal scans were done. Ten children survived the disease to date. They had significantly higher bilirubin and alkaline phosphatase clearances and secreted bilirubins beginning 1 mo postoperatively than nonsurvivors. Six of the 10 survivors had improved secretory function after reoperation. Four required higher transection of ducts and two improved after relief of Roux-en-Y biliary loop obstruction. The exact criteria for reoperation are not