Acquired disorders of the biliary tract in children

Acquired diseases of the biliary tract are less common in children than in adults. Gallstones, sclerosing cholangitis and biliary complications after liver transplantation are the most frequent problems but biliary obstruction can be secondary to pancreatitis, tumours and biliary sludge and bile leaks are a recognized risk following trauma to the liver. Biliary disease may be asymptomatic and suspected due to abnormal liver function tests or ultrasound scan. Right sided abdominal pain, features of biliary obstruction or sepsis occur in symptomatic children. Identification and relief of biliary obstruction requires a collaborative approach involving paediatric hepatologist, surgeon and radiologist. In those with long standing cholestasis, as can occur in sclerosing cholangitis, supportive management of itching and nutrition improves quality of life. The outcome following liver transplantation for those progressing to end stage liver disease is very good.