Choledochal cysts in African infants: a report of 3 cases and a review of the literature.

Choledochal cysts are relatively rare and are an uncommon cause of cholestasis. Early diagnosis and prompt treatment can prevent complications such as cholangitis, cirrhosis and portal hypertension. This article reviews a rarely reported disease in Africans in whom only 3 cases were documented over the 18 year period in Nigeria. The 3 cases were all females with ages between less than a month and 13 months at presentation. All presented with abdominal swelling with or without jaundice or acholic stools. The use of real-time ultrasonography antenatally and postnatally aided the diagnosis in our patients. Two of the patients presented and were operated and both made full recovery confirming the importance of early surgical intervention. The third patient died, and exemplified the consequences of delayed diagnosis and treatment which occur not uncommonly in developing countries mostly because of sparse and or expensive tertiary health care facilities.

Duodenal intubation and aspiration test: utility in the differential diagnosis of infantile cholestasis.

A prospective study involving 27 infants with cholestatic jaundice was carried out to evaluate the diagnostic utility of the 24-h duodenal drainage test. Extrahepatic cholestasis was confirmed by either exploratory laparotomy or autopsy in 12 of 13 cases without bile drainage, with only one false-positive result. The sensitivity of this test for extrahepatic cholestasis was 100% while the accuracy and specificity were 96.3 and 93.3%, respectively. The corresponding sensitivity, accuracy, and specificity for liver biopsy in patients with extrahepatic cholestasis were 83.3, 92.6, and 100%, respectively. It is concluded that the duodenal drainage test is a simple, rapid, and inexpensive procedure with high sensitivity and specificity in the diagnosis of infantile cholestasis.