[Spiral cholangioscanners and tridimensional reconstructions of the biliary tract in children].

PURPOSE

endoscopic retrograde cholangiography may be difficult or unfeasible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contribution of spiral CT cholangiography in pediatric patients.

SUBJECTS AND METHODS

seven patients, age ranging from 10 months to 13 years were explored without general anesthesia. Eight spiral CT cholangiographies were performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of iodipamide (Transbilix-Guerbet). The dose was correlated to the body surface. 3D reconstructions were done using the surface rendering or the MIP technique.

RESULTS

biliary tract opacification and 3D reconstructions were considered of good quality in 6 out of 8 studies. It was normal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile ducts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quality due to inadequate sedation and a case of Caroli's disease with a high serum bilirubin level. Four patients had an endoscopic or a percutaneous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of Caroli's disease.

CONCLUSION

spiral CT is feasible even in young children. It should reduce the indications for endoscopic or percutaneous cholangiography. It has to be performed as the first examination in cases of biliary or pancreatic diseases when surgery is contemplated.