Exploring the Role of Percutaneous Transhepatic Biliary Drainage in the Interim Management of Paediatric Choledochal Cysts with Cholangitis: A Pilot Study.

Background

Choledochal cysts are congenital anomalies of the bile ducts that can lead to significant complications, such as cholangitis, liver fibrosis, and biliary obstruction. This study aims to evaluate the effectiveness and safety of percutaneous transhepatic biliary drainage (PTBD) in managing choledochal cysts with cholangitis in children.

Methods

This non-randomized interventional study included twelve paediatric patients with choledochal cysts and cholangitis treated over two years. Percutaneous transhepatic biliary drainage was performed to relieve biliary obstruction and stabilize patients before definitive surgical repair. Data were collected on patient demographics, clinical presentation, haematological and biochemical profiles, imaging findings, procedural details, and outcomes.

Results

Of the 12 children, 8 (66.7%) were female, with a mean age of 55 ± 55 months. Jaundice was present in 11 (91.7%), abdominal pain in 10 (83.3%), vomiting in 9 (75.0%), and fever in 6 (50.0%). Baseline bilirubin and liver enzymes were elevated in all cases. Following PTBD, bilirubin levels decreased by 56% (median) by day 7, with 90% symptom resolution. Eight patients proceeded to surgery, while three had unfavorable outcomes. No major PTBD-related complications occurred. At follow-up, all surgically treated patients had normalized liver function, with histopathology showing periportal fibrosis in 50% of cases.

Conclusion

Percutaneous transhepatic biliary drainage was associated with clinical and biochemical stabilization in selected high-risk patients and may serve as an interim strategy before definitive surgery. Larger controlled studies are required to clarify its impact on outcomes.