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Hepatobiliary, Pancreatic and Splenic Disease in Children. Medical and Surgical Management
  1. D A KELLY

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Hepatobiliary, Pancreatic and Splenic Disease in Children. Medical and Surgical Management. Balistreri W F, Ohi R, Todani T, Tsuchida Y, eds. (Pp 605; illustrated; 495.) Amsterdam: Elsevier Science, 1997. ISBN 0-444-82052-3.

This is an earnest and well meaning book written by mainly Japanese and American authors. Although entitled Medical and Surgical Management of Hepatobiliary, Pancreatic and Splenic Disease in Children, this book concentrates on surgical management of selected topics and cannot be considered a comprehensive guide to the medical management of paediatric liver disease.

Nevertheless the book has many strengths. There are five chapters on basic morphology and physiology of the liver which include an excellent summary of the embryology of the liver and bile ducts in this rapidly developing field, and details of the development of the pancreas, including the normal and variant anatomy, which would be helpful to both surgeons and endoscopists. This was followed by a fascinating chapter on the functional development of the liver which explains many of the difficulties experienced by neonates with liver disease. There are very detailed chapters on bilirubin and bile acid metabolism which explore the basis for neonatal jaundice and inborn errors of bile salt metabolism.

The next series of chapters are devoted to the investigation of the child with liver disease. I found the chapter on the role of liver biopsy disappointing as it contains a number of factual errors (for example, Wilson’s disease does not present with neonatal cholestasis) and does not discuss the difficulties of making an early histological diagnosis of biliary atresia, which is an important practical problem in the 1990s.

The chapters on the role of imaging with ultrasound and hepatoscintigraphy are more detailed than would be required and although clinical applications are discussed, clear guidelines are not obvious, particularly as scintigraphy is now rarely used. In contrast the chapter on the use of magnetic resonance imaging and computed tomography scanning is both well written and relevant.

The chapters devoted to the use of percutaneous transhepatic cholangiography and endoscopic cholangiopancreatography are brief and many important indications for these techniques are not included (for example, sclerosing cholangitis, post-transplant complications).

In the clinical section of the book, the chapter on neonatal cholestasis provides a good practical guide to the investigation and management of these infants, but no other medical liver diseases are included with the exception of cystic fibrosis.

Given the importance of biliary atresia to the Japanese community, it is not surprising that this disease is over represented in this book. There is a long and detailed chapter concentrating on the surgical aspects of hepatic portoenterostomy which duplicates information in earlier chapters.

The surgical highlights include an up to date and relevant chapter on the medical and surgical aspects of portal hypertension by Professor Howard, and a detailed review of liver trauma which will be of considerable help to both paediatricians and surgeons caring for children with abdominal trauma.

No book on liver disease would be complete without a chapter or chapters on liver transplantation. Transplantation from both cadaveric and living donors is discussed with the emphasis very firmly on the surgical approach and management. There is little attempt to provide information on quality of life and survival.

Pancreatic disease in childhood is rare and one the strengths of this book is to explore the management of pancreatitis, pancreatic trauma and of pancreatic tumours.

A whole section is devoted to diseases of the spleen—for example, trauma and multi-system involvement, which is unusual but it was fascinating to discover the entity of the wandering spleen. Although the technique of splenectomy is discussed, the indications for this usually unnecessary procedure are not included.

In summary, this is a rather patchy book with strengths in basic physiology and morphology and sound on surgical technique and detail. I am sure that it will provide a useful reference book for young surgeons but will disappoint paediatricians looking for comprehensive medical management of hepatobiliary disease.

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