Surgery for biliary tract problems in children

Jaundice in the neonate is common and when not associated with symptoms or signs of systemic illness may at first be regarded with some complacency by both mother and health professional alike. When the cholestatic nature of the jaundice becomes apparent, a cause must be identified, if possible within 2 weeks of onset. Biliary atresia, choledochal cyst, inspissated bile syndrome and spontaneous perforation of the bile duct are the most frequent surgical causes. An investigation protocol includes stool observation, ultrasound scanning, biochemical liver function tests, a screen for infective and metabolic causes, a radioisotope excretion scan (hydroxyiminodiacetic acid HIDA scan) and, if necessary, operative cholangiogram and liver biopsy. Surgical management, if performed timeously, may prevent progression of parenchymal disease and in many cases can be curative. Delayed diagnosis leads to inevitable progression of liver damage with a poor long-term outlook. Cholelithiasis is being seen more frequently both in the infant and older child. Surgical intervention is required for symptomatic disease and for stones in the common bile duct. Tumours of the bile ducts are rare but are most likely to be malignant and should be referred to specialist centres for management.