Clinical course of obstructive jaundice associated with operated meconium peritonitis in neonates.
OBJECTIVE
Meconium peritonitis (MP) may induce prolonged cholestasis after laparotomy. In this study, we investigated the postoperative clinical course of MP retrospectively and discuss the relationship between MP and the development of obstructive jaundice, including biliary atresia (BA).


METHODS
Between 1979 and 2008, 23 infants with MP underwent laparotomy at our institution. Eleven of the 23 infants (47.8%) developed obstructive jaundice postoperatively. The medical charts of these 11 infants were reviewed.


RESULTS
The causative disease underlying MP included jejunoileal atresia in 10 and cloacal anomaly in 1. Of these 11 infants, 4 had acholic stools. Nine of the 11 improved with conservative management including an expectant approach, choleretic agents, and exchange blood transfusion. To differentiate the diagnosis from BA, open cholangiography was required in 2 cases following negative HIDA scintigraphy and a small gallbladder on ultrasonography. One of these 2 cases was diagnosed as BA and underwent hepatic portoeneterostomy simultaneously, after which the infant became jaundice free.


CONCLUSIONS
Postoperative cholestasis after MP was a transient condition in most cases. However, ultrasonography and HIDA scintigraphy should be performed to differentiate BA in infants with MP who show prolonged jaundice with acholic stools.
Sakai
K
K
Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ono
S
S
Fumino
S
S
Shimadera
S
S
Iwai
N
N
D002758:Cholangiography; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008470:Meconium; D010538:Peritonitis / Q000601:surgery*; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome