Management of biliary tract problems

Biliary disorders are relatively rare in childhood but early recognition is important and investigations need to be organized efficiently to facilitate a timely diagnosis and specific treatment. The classical clinical presentation of biliary disorders is with jaundice, particularly in the newborn period, abdominal pain and fever but incidental antenatal diagnosis is becoming an increasingly important presentation. Abdominal ultrasound remains the imaging modality of choice but magnetic resonance cholangiopancreotography and endoscopic ultrasound have an increasing role. The role of endoscopic retrograde cholangiopancreotography has evolved from a diagnostic to a therapeutic tool. Surgical treatment is necessary for many biliary disorders and while laparoscopic cholecystectomy is now the standard of care, open surgery remains the preferred method for Kasai Portoenterostomy. This review article focuses on the clinical features of biliary disorders in childhood and the diagnostic tools available. The epidemiology, clinical features and treatment of the most important biliary tract problems are then discussed.