Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants.
BACKGROUND
Once it is established that a jaundiced infant has an elevated direct bilirubin level, the principal diagnostic concern is the differentiation of hepatocellular from obstructive cholestasis, of disorders of physiology from disorders of anatomy, and of disease that is managed medically from disease that is managed surgically. Traditional tests such as ultrasonography, liver biopsy, and technotium 99m HIDA scan are often not sufficiently discriminating. General anesthesia is required for invasive imaging with endoscopic retrograde cholangio pancreatography (ERCP) or operative cholangiogram. The authors describe a facile alternative using percutaneous cholecystocholangiography (PCC) with intravenous sedation.


METHODS
Nine cholestatic infants underwent PCC (age, 27 to 73 days; mean, 44 days) after ultrasoundscan, liver biopsy, and (99mTc)HIDA scan failed to provide a definitive diagnosis.


RESULTS
In the 4 infants without complete biliary filling, we found biliary atresia (3) and biliary hypoplasia (1). The biliary tree was completely opacified in 5 infants with the following diagnosis: neonatal hepatitis (2), duplication of the gallbladder (1), choledochocele (1), total parenteral nutrition (TPN) cholestasis (1). There were no complications.


CONCLUSIONS
When the etiology of cholestasis remains elusive after traditional firstline tests, PCC has proven to be an accurate simple alternative in differentiating obstructive from hepatocellular causes of infantile cholestatic jaundice.
Meyers
Rebecka L
RL
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, UT 84113, USA.
Book
Linda S
LS
O'Gorman
Molly A
MA
White
Keith W
KW
Jaffe
Richard B
RB
Feola
Peter G
PG
Hedlund
Gary L
GL
D001656:Biliary Atresia / Q000150:complications / Q000000981:diagnostic imaging; D002758:Cholangiography / Q000379:methods; D002765:Cholecystography / Q000379:methods; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000150:complications / Q000000981:diagnostic imaging*