ANTENATAL DIAGNOSIS OF CONGENITAL-ANOMALIES OF THE BILIARY-TRACT

Background: The accuracy of the technique of antenatal ultrasonography in the diagnosis of congenital bile duct lesions is unknown. Methods: Thirteen patients with proven biliary disease who had abnormal antena tal scans were reviewed. Two infants had type I cystic biliary atresia and one had a noncommunicating segmental dilatation of the bile duct in a type 3 biliary atresia. The remainder had choledochal cysts and i ncluded two patients with intrahepatic cysts. The correct diagnosis wa s made antenatally in only two (15%) cases. Of the remaining patients, seven received a diagnosis of intraabdominal cysts of unknown etiolog y, three of duodenal atresia, and one ovarian cyst. The median gestati onal age at the antenatal diagnosis was 20 weeks. Results: Jaundice de veloped in 11 infants, and dilatation of intrahepatic biliary radicals was noted in four of the choledochal cysts. Obstructive jaundice and increasing cyst size were indications for early surgery, and twelve in fants underwent a laparotomy at a median age of 4 weeks. During the me dian follow-up period of 2 years, 12 of the 13 patients have lost thei r jaundice or remained anicteric. Antenatal diagnosis offers the possi bility of early definitive surgery for uncomplicated choledochal dilat ation and the chance of improved outcome for surgically treated biliar y atresia. An algorithm is suggested for the management of antenatally detected cystic biliary lesions. Copyright (C) 1998 by W.B. Saunders Company.