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720 Adequate Postnatal Diagnostic Modalities for Prenatally Diagnosed Biliary Cystic Malformations
  1. T Okada,
  2. S Honda,
  3. H Miyagi,
  4. A Taketomi
  1. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan


Background and Aims The aim of this study was to determine an appropriate postnatal diagnostic management plan for prenatally diagnosed biliary cystic malformation (BCM) patients.

Methods From 2002 to 2011, a total of 27 consecutive children with pancreaticobiliary maljunction (PBM) were treated at our institute. Eight (29.6%) of our 27 patients with choledochal cyst (CC) were diagnosed prenatally and examined clinically. Prenatally diagnosed cystic biliary atresia (BA) was noted in 2 patients with type 1 cystic BA. The clinical data, preoperative imaging findings, and final diagnosis using intraoperative cholangiography were evaluated in these BCM patients.

Results Infants with prenatally diagnosed CC were divided into two groups after birth: a symptomatic group of 5 patients, and an asymptomatic group of 3 patients. According to CC patients, ultrasonography (US) did not reveal a PBM in all 8 CC patients, although the main pancreatic duct was shown in 2 CC patients. The PBM and main pancreatic duct were shown by MRCP at high rates of 80 and 60%, respectively, compared with US and dynamic CT. In cystic BA patients, US and MRCP showed that the gallbladder was atrophic in both of the two cystic BA patients compared with the CC patients. There was not triangular cord sign in the two by US.

Conclusion This study clearly showed that, in some cases, such as prenatally diagnosed BCM, MRCP eliminates the need for endoscopic retrograde cholangiopancreatography (ERCP) because of its excellent sensitivity and specificity, thus avoiding an invasive procedure with marked radiation exposure.

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