Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Operative Cholangiography in the Diagnosis of Prolonged Jaundice in Infancy

Operative Cholangiography in the Diagnosis of Prolonged Jaundice in Infancy Operative Cholangiography in the Diagnosis of Prolonged Jaundice in Infancy 1 John H. Harris Jr. , M.D. 2 A. Edward O'Hara , M.D. 3 1740 Bainbridge St. Philadelphia 46, Penna. C. Everett Koop , M.D., Sc.D. (Med.) 4 ↵ 1 From The Departments of Radiology and Surgery, The Children's Hospital of Philadelphia, and The Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania. Presented as part of a Pediatric Panel at the Forty-Third Annual Meeting of the Radiological Society of North America, Chicago, Ill., Nov. 1722, 1957. ↵ 2 Associate Radiologist, Carlisle Hospital, Carlisle, Pennsylvania; formerly Resident in Radiology, The Children's Hospital of Philadelphia and The Hospital of the University of Pennsylvania. ↵ 3 Associate Radiologist, The Children's Hospital of Philadelphia. ↵ 4 Surgeon-in-Chief, The Children's Hospital of Philadelphia. Excerpt Many contributions have appeared in the recent roentgenologic literature relative to operative cholangiography, and in many institutions it is a routine procedure during adult biliary tract surgery. In contrast, there has been no mention of the usefulness of delineating the biliary ductal system in similar circumstances arising in pediatric surgery. A review of the nonradiologic literature disclosed but two articles specifically pertaining to the application of operative cholangiography in infancy (18, 23). Several other authors mention the procedure as being of value in elucidating the etiology of obstructive jaundice in infants and in facilitating the pending surgical procedure (5–8). The purpose of this paper is to describe the technic of operative cholangiography that has been used at The Children's Hospital of Philadelphia, to illustrate the roentgen findings in the normal infant biliary ductal system (Figs. 1, 2, 3, and 5), to present illustrative cases of the more commonly encountered types of extrahepatic biliary atresias (Figs. 4, 6, 7, and 8), and to discuss briefly the problem of jaundice in the newborn with special reference to the obstructive type. Hsia et al . (10), in a review of 156 cases of obstructive jaundice in infancy seen at the Children's Medical Center of Boston, reported that 60 per cent were caused by biliary atresia. A similar review by Gerrish and Cole (4) revealed congenital atresia of the bile ducts to be the etiologic factor in 61 per cent of 41 cases of surgical jaundice in infants and children. In 1954, Redo (16) reviewed 300 cases of congenital atresia of the extrahepatic bile ducts from the literature and added to these 27 cases. This anomaly can therefore no longer be considered a medical curiosity. In fact, it is the commonest cause of obstructive jaundice in infancy. Holmes, as early as 1916 (9), suggested that certain types of biliary atresia were amenable to surgical correction. Since that time, many different operative procedures have been advocated. The percentage of extra-hepatic biliary atresias amenable to surgical correction has been variously reported as being from 18 to 37 per cent (5, 11, 15, 16). Some of these estimates, however, are based on small series, and it is our belief that figures higher than 20 per cent are unrealistic. Surgery of the biliary passages is frequently difficult in adults. In infants and children, because of the size of the biliary ducts, the technical difficulties are increased. Furthermore, needless surgery in the region of the bile ducts is to be avoided, if at all possible, because of subsequent cicatricial complications. The role of the roentgenologist in surgical jaundice in infants and children therefore assumes considerable importance. If the biliary tree can be shown to be normal, exploration is not justified. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Operative Cholangiography in the Diagnosis of Prolonged Jaundice in Infancy

Harris, John H.; Everett Koop, C.
Radiology , Volume 71 (6): 806 – Dec 1, 1958
Download PDF
10 pages

Loading next page...
 
/lp/radiological-society-of-north-america-inc/operative-cholangiography-in-the-diagnosis-of-prolonged-jaundice-in-QwLTo0MSfs

References (17)

Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1958 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/71.6.806
pmid
13624032
Publisher site
See Article on Publisher Site

Abstract

Operative Cholangiography in the Diagnosis of Prolonged Jaundice in Infancy 1 John H. Harris Jr. , M.D. 2 A. Edward O'Hara , M.D. 3 1740 Bainbridge St. Philadelphia 46, Penna. C. Everett Koop , M.D., Sc.D. (Med.) 4 ↵ 1 From The Departments of Radiology and Surgery, The Children's Hospital of Philadelphia, and The Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania. Presented as part of a Pediatric Panel at the Forty-Third Annual Meeting of the Radiological Society of North America, Chicago, Ill., Nov. 1722, 1957. ↵ 2 Associate Radiologist, Carlisle Hospital, Carlisle, Pennsylvania; formerly Resident in Radiology, The Children's Hospital of Philadelphia and The Hospital of the University of Pennsylvania. ↵ 3 Associate Radiologist, The Children's Hospital of Philadelphia. ↵ 4 Surgeon-in-Chief, The Children's Hospital of Philadelphia. Excerpt Many contributions have appeared in the recent roentgenologic literature relative to operative cholangiography, and in many institutions it is a routine procedure during adult biliary tract surgery. In contrast, there has been no mention of the usefulness of delineating the biliary ductal system in similar circumstances arising in pediatric surgery. A review of the nonradiologic literature disclosed but two articles specifically pertaining to the application of operative cholangiography in infancy (18, 23). Several other authors mention the procedure as being of value in elucidating the etiology of obstructive jaundice in infants and in facilitating the pending surgical procedure (5–8). The purpose of this paper is to describe the technic of operative cholangiography that has been used at The Children's Hospital of Philadelphia, to illustrate the roentgen findings in the normal infant biliary ductal system (Figs. 1, 2, 3, and 5), to present illustrative cases of the more commonly encountered types of extrahepatic biliary atresias (Figs. 4, 6, 7, and 8), and to discuss briefly the problem of jaundice in the newborn with special reference to the obstructive type. Hsia et al . (10), in a review of 156 cases of obstructive jaundice in infancy seen at the Children's Medical Center of Boston, reported that 60 per cent were caused by biliary atresia. A similar review by Gerrish and Cole (4) revealed congenital atresia of the bile ducts to be the etiologic factor in 61 per cent of 41 cases of surgical jaundice in infants and children. In 1954, Redo (16) reviewed 300 cases of congenital atresia of the extrahepatic bile ducts from the literature and added to these 27 cases. This anomaly can therefore no longer be considered a medical curiosity. In fact, it is the commonest cause of obstructive jaundice in infancy. Holmes, as early as 1916 (9), suggested that certain types of biliary atresia were amenable to surgical correction. Since that time, many different operative procedures have been advocated. The percentage of extra-hepatic biliary atresias amenable to surgical correction has been variously reported as being from 18 to 37 per cent (5, 11, 15, 16). Some of these estimates, however, are based on small series, and it is our belief that figures higher than 20 per cent are unrealistic. Surgery of the biliary passages is frequently difficult in adults. In infants and children, because of the size of the biliary ducts, the technical difficulties are increased. Furthermore, needless surgery in the region of the bile ducts is to be avoided, if at all possible, because of subsequent cicatricial complications. The role of the roentgenologist in surgical jaundice in infants and children therefore assumes considerable importance. If the biliary tree can be shown to be normal, exploration is not justified.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Dec 1, 1958

There are no references for this article.