Case report 50
Obstructive Jaundice in Kawasaki's Disease C. Luzzatto 1, M. Chiesura-Corona2 , L. Zancan 3, M. Guglielmi 1 of Paediatric Surgery, 2 Institute of Radiology and 3 Department of Paediatries, University of Padua, Italy
Summary We describe a case of Kawasaki's disease in a 10-year-old child who had obstructive jaundice, intrahepatic biliary duct dilatation and gallbladder hydrops. The diagnosis was defined by echography, CT-scan and cholangiography. Immediate relief from symptoms and progressive resolution of jaundice was achieved by percutaneous transhepatic biliary drainage (PTBD). Laparotomy was avoided.
Keywords Kawasaki's disease - Jaundice - Gallbladder hydrops - Bile ducts, percutaneous drainage
Since patients with abdominal symptoms have been routinely examined by echography, gallbladder hydrops has been reported with increasing frequency; its incidence has risen from 2.9 % (1) to 13.7 % (3) in different series. The incidence of jaundice is 18.7 % in aseries of 16 patients with gallbladder hydrops described by Suddieston (4). The serum bilirubin level is raised mainly in the conj ugated fraction, but adefinite cause for obstruction to the biliary flow has never been demonstrated. In fact, whenever cholangiography was performed, the biliary tree was always of normal caliber (8). We describe a case of Kawasaki's disease with gallbladder hydrops, dilatation of intrahepatic biliary ducts and severe jaundice, that was treated conservatively by percutaneous transhepatic biliary drainage (PTBD).
Case report Obstruktive Gelbsucht beim KawasakiSyndrom Wir berichten über einen Fall von Kawasaki-Syndrom bei einem zehnjährigen Knaben mit obstruktivem Ikterus, Erweiterung der intrahepatischen Gallengänge und Hydrops der Gallenblase. Die Diagnose wurde mittels Sonographie, CT-Scan und Cholangiographie gestellt. Eine sofortige Besserung der Symptome und insbesondere des Ikterus wurde mit Hilfe einer transhepatischen Gallenwegsdrainage (PTBD) erreicht. Eine Laparotomie konnte so vermieden werden.
Schlüsselwörter Kawasaki-Syndrom-Obstruktion - Ikterus Hydrops der Gallenblase - Transhepatische Gallenwegsdrainage
Kawasaki's disease is an acute illness of unknown orlgln characterised by fever lasting more than one week, which does not respond to antibiotics; conjunctivitis, alterations of lips, oral cavity and peripheral extremities, cutaneous exanthema and lymphnodal swelling (3) are also seen.
Reeeived March 30, 1989 Z Kinderehir 45 (1990) 50-51 Hippokrates Verlag Stuttgart
A 10-year-old boy was admitted to the Paediatric Surgery Department of Padua University for obstructive jaundice. Bronchial asthma was the only finding in his past medical history. His illness had begun 10 days before admission with ear pain, fever (39°C), anorexia, stiff neck and left cervical nodal swelling, followed by scarlatiniform exanthema, redness of pharynx and mild conjunctivitis. He had been treated with amoxicillin without improvement. On the 7th day of illness the child presented jaundice, vomiting, and acholie stools. Deterioration of his general condition prompted admittance to a peripheral hospital and immediate transferral to our Department, after the first clinical investigations. On admission, most of the initial clinical signs were resolved. Physical examination revealed afebrile (38°C), jaundiced child with dry fissured lips. He had lost 2 kg in weight since the beginning of his illness~ he was severely debilitated, and complained of abdominal pain and itching. The abdomen was tender at palpation in the right upper quadrant. The liver and the tensely distended gallbladder were feIt 8 cm. below the costal margin. Pertinent laboratory data on admission were as folIows: Hb 9.4 g/dl; WBC count 17,530 x 10lL with marked neutrophilia (860/0); platelet count 593 x 10 IL; ESR 90 mm/h; serum bilirubin level 193.2 Jlmol/L (conjugated 177.8 Jlmol/L); AST 90 U/L; ALT 106 U/L; GT 620 U/L; alkaline phosphatase 359 U/L; prothrombin time 70 %; antistreptolysine 0 tille 200. Ultrasound examination of the abdomen showed homogeneous enlargement of liver parenchyma and markedly distended gallbladder, measuring 10 x 3.5 cm. in its principal axes, with anechoic content. The intrahepatic ducts appeared widely enlarged without distension of the common bile duct. CT-scan of the abdomen confirmed the echographie findings. Percutaneous transhepatic cholangiography was performed under fluoroscopic control. The contrast medium filled both the right and left hepatic duct systems down to the confluence, while the common and cystie duct had a thread-like appearance. The gallbladder was not visualized and there was only a very slight contrast medium discharge into the duodenum. A drainage catheter with multiple side holes,
Downloaded by: University of Pennsylvania Libraries. Copyrighted material.
1Department
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Obstructive Jaundice in Kawasaki's Disease C. Luzzatto 1, M. Chiesura-Corona2 , L. Zancan 3, M. Guglielmi 1 of Paediatric Surgery, 2 Institute of Radiology and 3 Department of Paediatries, University of Padua, Italy
Summary We describe a case of Kawasaki's disease in a 10-year-old child who had obstructive jaundice, intrahepatic biliary duct dilatation and gallbladder hydrops. The diagnosis was defined by echography, CT-scan and cholangiography. Immediate relief from symptoms and progressive resolution of jaundice was achieved by percutaneous transhepatic biliary drainage (PTBD). Laparotomy was avoided.
Keywords Kawasaki's disease - Jaundice - Gallbladder hydrops - Bile ducts, percutaneous drainage
Since patients with abdominal symptoms have been routinely examined by echography, gallbladder hydrops has been reported with increasing frequency; its incidence has risen from 2.9 % (1) to 13.7 % (3) in different series. The incidence of jaundice is 18.7 % in aseries of 16 patients with gallbladder hydrops described by Suddieston (4). The serum bilirubin level is raised mainly in the conj ugated fraction, but adefinite cause for obstruction to the biliary flow has never been demonstrated. In fact, whenever cholangiography was performed, the biliary tree was always of normal caliber (8). We describe a case of Kawasaki's disease with gallbladder hydrops, dilatation of intrahepatic biliary ducts and severe jaundice, that was treated conservatively by percutaneous transhepatic biliary drainage (PTBD).
Case report Obstruktive Gelbsucht beim KawasakiSyndrom Wir berichten über einen Fall von Kawasaki-Syndrom bei einem zehnjährigen Knaben mit obstruktivem Ikterus, Erweiterung der intrahepatischen Gallengänge und Hydrops der Gallenblase. Die Diagnose wurde mittels Sonographie, CT-Scan und Cholangiographie gestellt. Eine sofortige Besserung der Symptome und insbesondere des Ikterus wurde mit Hilfe einer transhepatischen Gallenwegsdrainage (PTBD) erreicht. Eine Laparotomie konnte so vermieden werden.
Schlüsselwörter Kawasaki-Syndrom-Obstruktion - Ikterus Hydrops der Gallenblase - Transhepatische Gallenwegsdrainage
Kawasaki's disease is an acute illness of unknown orlgln characterised by fever lasting more than one week, which does not respond to antibiotics; conjunctivitis, alterations of lips, oral cavity and peripheral extremities, cutaneous exanthema and lymphnodal swelling (3) are also seen.
Reeeived March 30, 1989 Z Kinderehir 45 (1990) 50-51 Hippokrates Verlag Stuttgart
A 10-year-old boy was admitted to the Paediatric Surgery Department of Padua University for obstructive jaundice. Bronchial asthma was the only finding in his past medical history. His illness had begun 10 days before admission with ear pain, fever (39°C), anorexia, stiff neck and left cervical nodal swelling, followed by scarlatiniform exanthema, redness of pharynx and mild conjunctivitis. He had been treated with amoxicillin without improvement. On the 7th day of illness the child presented jaundice, vomiting, and acholie stools. Deterioration of his general condition prompted admittance to a peripheral hospital and immediate transferral to our Department, after the first clinical investigations. On admission, most of the initial clinical signs were resolved. Physical examination revealed afebrile (38°C), jaundiced child with dry fissured lips. He had lost 2 kg in weight since the beginning of his illness~ he was severely debilitated, and complained of abdominal pain and itching. The abdomen was tender at palpation in the right upper quadrant. The liver and the tensely distended gallbladder were feIt 8 cm. below the costal margin. Pertinent laboratory data on admission were as folIows: Hb 9.4 g/dl; WBC count 17,530 x 10lL with marked neutrophilia (860/0); platelet count 593 x 10 IL; ESR 90 mm/h; serum bilirubin level 193.2 Jlmol/L (conjugated 177.8 Jlmol/L); AST 90 U/L; ALT 106 U/L; GT 620 U/L; alkaline phosphatase 359 U/L; prothrombin time 70 %; antistreptolysine 0 tille 200. Ultrasound examination of the abdomen showed homogeneous enlargement of liver parenchyma and markedly distended gallbladder, measuring 10 x 3.5 cm. in its principal axes, with anechoic content. The intrahepatic ducts appeared widely enlarged without distension of the common bile duct. CT-scan of the abdomen confirmed the echographie findings. Percutaneous transhepatic cholangiography was performed under fluoroscopic control. The contrast medium filled both the right and left hepatic duct systems down to the confluence, while the common and cystie duct had a thread-like appearance. The gallbladder was not visualized and there was only a very slight contrast medium discharge into the duodenum. A drainage catheter with multiple side holes,
Downloaded by: University of Pennsylvania Libraries. Copyrighted material.
1Department
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Di.I'U- ion Tu ollr h11O\\ ledg(' Ihis i lh' fi ..... 1 I' ported '
