Biliary Disease
The meeting focused on the increasing prevalence of biliary disease in children--particularly because of the obesity epidemic--and the importance of learning from different approaches to managing these diseases. The team discussed various cases, including a 2-year-old patient with a common bile duct dilatation and a patient with a suspected polycystic liver disease, and the necessity of intraoperative cholangiogram in surgical procedures. The meeting also covered risk factors for gallstone disease in the pediatric population, the possibility of biliary anomalies, and the importance of considering these factors when making surgical decisions.
Case 1. Pancreatitis in a Young Female
Discussed was a case of a 2 yo female patient who presented with vomiting, lethargy, and low appetite. The patient was previously healthy and did not have any abdominal pain. The patient was diagnosed with pancreatitis, based on elevated lipase levels and a high white blood cell count. The team discussed potential causes of pancreatitis in a young patient, ruling out gallstone disease due to the patient's age and lack of risk factors. They considered the possibility of anatomic abnormalities, such as a colloid cyst or annular pancreas, and the need to investigate further for potential hepatobiliary anomalies.
Case 2. Gallstone Disease Risk Factors in Pediatrics
The team discussed the recovery of a patient who underwent surgery for a polycholedochal cyst. The patient had a smooth recovery, with normal liver enzymes and no complications. Pathology of the cyst was discussed, noting that it was dilated but had no inflammation or fibrosis. Choleidochal cysts can be congenital or acquired, with the latter often caused by a long common pancreaticobiliary duct leading to reflux of pancreatic secretions into the biliary tree. Also mentioned was that the incidence of biliary reflux in such cases is around 6-7%. The conversation ended with a presentation by a medical student about a 6-yo female patient with a history of right Wilm's tumor who presented with abdominal pain and was found to have sludge in the gallbladder.
S-R-P Patient Case Discussions