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Percutaneous cholecysto-cholangiography in the diagnosis of obstructive jaundice in infants
Rebecka L Meyers1, Linda S Book, Molly A O'Gorman
1Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, UT 84113, USA.
Insights
Percutaneous cholecystocholangiography (PCC) is an accurate and simple alternative for diagnosing cholestatic jaundice in infants when other tests fail. This minimally invasive procedure helps differentiate between obstructive and hepatocellular causes, guiding appropriate medical or surgical management.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatology
Background:
- Infantile cholestatic jaundice requires differentiating hepatocellular from obstructive causes.
- Traditional diagnostic tools like ultrasound, biopsy, and HIDA scans often lack sufficient discriminatory power.
- Invasive imaging techniques such as ERCP require general anesthesia.
Purpose of the Study:
- To describe percutaneous cholecystocholangiography (PCC) as a simpler alternative for diagnosing infantile cholestasis.
- To evaluate the efficacy of PCC in differentiating obstructive from hepatocellular causes of jaundice.
Main Methods:
- Nine infants with cholestasis underwent PCC after initial diagnostic tests were inconclusive.
- Patients ranged from 27 to 73 days old (mean 44 days).
- The procedure was performed under intravenous sedation.
Main Results:
- PCC successfully opacified the biliary tree in 5 infants, leading to diagnoses of neonatal hepatitis, gallbladder duplication, choledochocele, and TPN cholestasis.
- In 4 infants with incomplete biliary filling, PCC identified biliary atresia (3) and biliary hypoplasia (1).
- No complications were reported during or after the PCC procedure.
Conclusions:
- PCC is an accurate and simple alternative for diagnosing the etiology of infantile cholestatic jaundice.
- It effectively differentiates obstructive from hepatocellular causes when first-line tests are insufficient.
- The procedure offers a less invasive option compared to traditional methods requiring general anesthesia.
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.
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