A practical algorithm for accurate diagnosis and treatment of perinatally identified biliary ductal dilation: three cases that underscore the importance of an individualised approach.

Choledochal cysts (CDCs) identified during the prenatal or immediate postnatal period are unusual with a majority being identified in older children and adults. Although authors advocate surgical resection of these presumed CDCs with reconstruction, there has been no agreement on the optimal timing of such an intervention when the initial diagnosis of CDC is made prenatally or during the newborn period. We present the cases of three children with biliary ductal dilation who were presumed to have CDC by ultrasound and/or magnetic resonance imaging during the perinatal period and who ultimately required different approaches to treatment. The eventual findings in these cases support a period of close postnatal observation followed by carefully planned individualised therapy.