Study on the Management of Prenatally Detected Cysts at the Hepatic Hilum

Abstract

Purpose: The differential diagnosis of cystic lesions at the hepatic hilum detected prenatally remains difficult. The aim of this study was to determine the factors that are helpful for differentiating between biliary atresia (BA) and congenital biliary dilatation (CBD) shortly after birth.
Methods: We reviewed the medical records of patients with prenatally detected cysts at the hepatic hilum in four institutions between April 2000 and October 2013. We divided the patients into BA and CBD groups, on the basis of operative findings and cholangiography. The preoperative findings of ultrasound and laboratory tests were compared in these groups.
Results: Ten patients were enrolled (BA, n = 6 and CBD, n = 4). In the BA group, two were diagnosed as having Type I cysts, with the others having Type IIId. The mean direct bilirubin (D-Bil.) levels shortly after birth (at 1 to 7 days of life) were significantly higher in the BA group than in the CBD group (2.7 ± 0.5 vs 0.5 ± 0.1 mg/dl, p = 0.0001). The mean AST and ALT levels shortly after birth were not significantly different between these groups, whereas in the BA group, they increased markedly after 20 days of life.
Conclusions: The high D-Bil. levels shortly after birth in the patients with the prenatally detected cysts at the hepatic hilum can indicate that the condition is BA rather than CBD. They should be monitored closely and undergo early radical operation before cholestatic liver injury begins.