title: Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants.
abstract: 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.
authors.affiliation: Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, UT 84113, USA.
authors.forename: Rebecka L
authors.initials: RL
authors.lastname: Meyers
authors.forename: Linda S
authors.initials: LS
authors.lastname: Book
authors.forename: Molly A
authors.initials: MA
authors.lastname: O'Gorman
authors.forename: Keith W
authors.initials: KW
authors.lastname: White
authors.forename: Richard B
authors.initials: RB
authors.lastname: Jaffe
authors.forename: Peter G
authors.initials: PG
authors.lastname: Feola
authors.forename: Gary L
authors.initials: GL
authors.lastname: Hedlund
mesh_terms: 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*