Prolonged jaundice

Abstract

Prolonged neonatal jaundice may be due to many different medical and surgical pathologies. Investigations in a jaundiced infant have to be carried on immediately to differentiate the medical causes from the surgical ones. The early diagnosis of surgical jaundice in a neonate is an important step as the success rate of the operation performed in extrahepatic biliary atresia (EHBA), is inversely proportional to the age of the patient. The diagnostic investigations have to be accelerated and the admittance of the patient to the surgical unit must not be delayed. In our institute, during the evaluation of an infant with prolonged jaundice, besides the biochemical and serological tests, fasting abdominal ultrasonography are carried out omitting hepatobiliary scintigraphy and fine needle liver biopsy. An atretic gallbladder and the positive triangular cord sign in the abdominal ultrasonography are highly suggestive of EHBA. The 2nd stage is to perform laparoscopic examination through a trocar inserted infraumbilically. Coarse, irregular liver surface with fine angiomatous development and greenish brown color are observed during laparoscopy in patients with EHBA. The liver is firm in touch with a device, and the gallbladder is, oftenly fibrotic and atretic. In the case of neonatal hepatitis (NH), the liver is smooth and chocolate brown in color and its edge is sharp with the voluminous gallbladder. If the passage of the contrast material is demonstrated in the proximal biliary tracts and the intestinal system with simultaneously performed cholangiographic examination, the diagnosis of NH is achieved and the operation is ended with fine needle liver biopsy. If the gallbladder is obviously atretic, no attempt is made to perform a cholangiography, but rather proceed to laparotomy. Laparoscopic examination of the liver with simultaneous cholangiography will provide the chance to achieve an earlier and accurate diagnosis. This approach, following abdominal ultrasonography, could be performed as the 2nd step of the diagnostic evaluation in neonates with prolonged jaundice. (Turk Arch Ped 2010; 45 Suppl: 42-5)