Ina Sorge (Universität Leipzig)  

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8 Years  

Female  

Abdomen-Liver  

physical  

8 year-old girl with hereditary spherocytosis. In the course of a routine examination, a bile duct obstruction was found. After initial conservative therapy, an endoscopic extraction of the concrement was performed (ERCP).  

Through hemolysis, increased uric acid, which makes an obstruction in the bile ducts possible.  

<- view Ultrasound 1

Ultrasound 1: Depiction of the concrement in the common bile duct (CBD), wich does not show an obvious acoustic shadow.




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MRI 1: (T2-weighted HASTE-Sequence): Depiction of the stone in the common bile duct (CBD) transversally; it is not completely signal free, which would speak for a calcified concrement, such as an oxalate stone.




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MRI 2: (mixed-weighted TRUFI-Sequence): Depiction of the stone in the common bile duct (CBD). It is noticeably dilated, a slight peripheral bilary duct dilatation is also seen.




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MRI 3: (MRCP-Image) Depiction of the stone in the common bile duct (CBD). This is noticeably dilated, a slight peripheral bilary duct dilatation is also seen. The pancreatic duct is not dilated, and is therefore not clearly seen.




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MRI 4: (MRCP-Image) One year after the endoscopic removal of the bilary duct stone, no proof of a stone on MRI nor on ultrasound. However, there is a scar related distal common bile duct stricture in the region of the papilla. Even the pancreatic duct is prominent, as well as the peripheral bilary ducts.




<- view Ultrasound 2

Ultrasound 2: Peripheral bilary ducts: One year after the endoscopic removal of the bilary duct stone there is no proof of a stone. However, there is a scar related distal common bile duct stricture in the region of the papilla. The central as well as the peripheral bilary ducts are dilated(double duct sign).




<- view Ultrasound 3

Ultrasound 3: Common bile duct dilatation (labelled as DC - ductus choledochus): One year after the endoscopic removal of the common bile duct stone, proof of a extrahepatic biliary obstruction with distal common bile duct dilatation on the sonogram.

 

Surgery / Histo  

Cholesterol concrement, Ureate concrement, Klatzkin tumor, Bilary duct polyp  

A cholecystectomy is not recommended before the 6th year of life. The endoscopic removal of a distal, single stone is an alternative, but can (like in our case) lead to a papillary stenosis.  

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Biliary duct, MRCP, concrement, stone, bile stone, bilirubin, oxalate, spherocytosis, ERCP, stenosis, bilirubin stone, hereditary Spherocytosis, Sphincter of Oddi, major papilla stricture, Papilla Vateri stenosis, Wirsung duct, endoscopic stone removal, endoscopic stone extraction, double duct sign, child, childhood, pediatric radiology  

Ina Sorge. Bilirubin Stone in Hereditary Spherocytosis, Papillary Stenosis after Endoscopic Stone Removal (ERCP). PedRad [serial online] vol 4, no. 1.
URL: www.PedRad.info/?search=20040118215842