MR cholangiopancreatography findings in children with spontaneous bile duct perforation

Abstract

BACKGROUND: Spontaneous bile duct perforation (SBP) is rare in children. Early diagnosis is important because the condition can be treated surgically.

OBJECTIVE: The purpose of this study is to report MR cholangiopancreatography (MRCP) findings of SBP and to evaluate the usefulness of MRCP.

MATERIALS AND METHODS: Over the last 10 years, three children (1 boy, 2 girls; ages 3, 4 and 15 months) underwent US, MRCP and hepatobiliary scintigraphy preoperatively and were surgically confirmed to have extrahepatic bile duct perforation.

RESULTS: US showed ascites in all children and a choledochal cyst in one. On MRCP, a moderate-to-large volume of ascites was seen in addition to a loculated fluid collection at the porta hepatis. MRCP also depicted the low insertion of the cystic duct and choledochal cyst in each case. Hepatobiliary scintigraphy showed bile leak from the region of the porta hepatis extending to the whole abdomen. According to the surgical findings, the perforation site was around the junction of the cystic duct and the common hepatic duct in all children.

CONCLUSION: In children with SBP, MRCP can depict the loculated fluid collection adjacent to the perforation site and associated bile duct anomalies.