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Gastroenterology, hepatology and nutrition

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E. Fitzpatrick, P. Farrant, J. Karani, M. Davenport, G. Mieli-Vergani, A. Baker.King’s College Hospital, London, UK

Introduction: The ultrasound finding of common bile duct (CB) dilatation (CBD) in jaundiced infants is often of uncertain significance. We wished to clarify the diagnostic and prognostic significance of CBD in infants ⩽3 months old presenting to a National Paediatric Liver Centre over a five-year period.

Methods: We reviewed the clinical, radiological and laboratory data of all infants <3 m with CBD >1.2 mm to determine mode of presentation, diagnosis, interventions and long-term outcome. Data were analysed with Epi-Info.

Results: Seventy eight infants (42 male) were identified, all of whom were initially referred with conjugated hyperbilirubinaemia. The mean gestation was 36.8 (SD 4.6) weeks. At presentation the mean CB size was 2.96 (SD 2.24) mm. Inspissated bile syndrome was shown in 49 (62.8%), 8 (10.3%) had causes of haemolysis. Choledochal cyst was found in 14.1% (11). CB dilatation was an incidental finding in 10 (12.8%) who had evidence of giant cell hepatitis, 2 with congenital infection, and 1 infant with a metabolic condition. 75% of infants were treated with ursodeoxycholic acid, 3.1% (2) required a biliary stent, and 5 underwent surgery (7%), 6 (8%) had percutaneous transhepatic cholangiography and 1 underwent endoscopic retrograde cholangiopancreatography. Overall, 30 (38%) had spontaneous resolution of the CBD; of these 12% had “grown into” an unchanged CB size rather than involution of dilatation. In a further 28% CBD had improved but not to normal. No patient remained jaundiced or had cholangitis. The mean size of CB at presentation for those with choledochal cyst was 5.73 (SD 2.93) mm versus 2.39 (SD 1.54) mm for the remainder (p<0.001). Of those who resolved spontaneously, the mean size of CB at presentation was 1.8 (SD 1.3) mm, and those in whom …

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