The spectrum of surgical jaundice in infancy
Section snippets
Materials and methods
King’s College Hospital (KCH), London, is a tertiary referral unit for pediatric hepatobiliary disease predominantly, but not exclusively, from the South of England. A retrospective review of all medical records of infants who presented to our institution over the 8-year period, January 1992 to December 1999, was carried out. The criteria for inclusion into the study were (1) origin from within the United Kingdom, (2) jaundice presenting within the first year of life, and (3) confirmation of a
Results
During the 8-year study period, 682 infants were referred to the pediatric hepatobiliary unit for investigation of jaundice. Within this group were 171 (25%) infants, born within the United Kingdom, where a “surgical” cause for jaundice was identified (Fig 1). Those infants were divided into 4 etiological groups for ease of comparison: (A) biliary atresia, (B) inspissated bile syndrome, (C) choledochal malformation, and (D) miscellaneous.
Discussion
The range of possible causes of surgical jaundice in infancy is well illustrated in this study with at least 8 different diagnoses. The most frequent diagnosis remains biliary atresia, accounting for about 80% of total cases. The incidence of other conditions can now be estimated if we assume that no selection or retention of cases occurred before referral. The calculated incidence of biliary atresia in the United Kingdom during the 1990s was 1 in 16,700 live births5 which suggests that the
Acknowledgements
The contribution of the whole of the multidisciplinary unit is acknowledged but particularly Dr P. Kane and Dr J. Karani (radiology); Professor B. Portmann (histopathology); Drs A. Baker, N. Hadzic, and A. Dhawan (pediatric hepatology); and N. Heaton and M. Rela (transplant surgery).
References (39)
- et al.
The frequency and outcome of biliary atresia in the UK and Ireland
Lancet
(2000) - et al.
Inflammatory pseudotumor of the liverCase report and review of the literature
J Pediatr Surg
(2001) Biliary atresia into the 21st centuryA historical perspective
Hepatology
(1996)- et al.
Antenatal diagnosis of congenital anomalies of the biliary tract
J Pediatr Surg
(1998) - et al.
Anomalous arrangement of the pancreaticobiliary ductal system in patients with a choledochal cyst
Am J Surg
(1984) - et al.
Macroscopic appearance at porto-enterostomy—A prognostic variable in biliary atresia
J Pediatr Surg
(1996) - et al.
Neonatal jaundiceThe role of laparoscopy
J Pediatr Surg
(2000) - et al.
A new diagnostic approach to biliary atresia with emphasis on the ultrasonographic triangular cord signComparison of ultrasonography, hepatobiliary scintigraphy and liver needle biopsy in the evaluation of infantile cholestasis
J Pediatr Surg
(1997) - et al.
Biliary atresiaKing’s College Hospital Experience (1974–1995)
J Pediatr Surg
(1997) - et al.
Surgical limitation for biliary atresiaIndication for liver transplantation
J Pediatr Surg
(1989)
Cholelithiasis in newborns and infants
J Pediatr Surg
Hepaticoenterostomy after excision of choledochal cyst in childrenA 30 year experience with 180 cases
J Pediatr Surg
Biliary amylase and congenital choledochal dilatation
J Pediatr Surg
Spontaneous biliary perforationDoes external drainage constitute adequate therapy?
J Pediatr Surg
Acquired biliary atresia
J Pediatr Surg
Clinical study of prolonged jaundice in breast and bottle-fed babies
Arch Dis Child
Investigation and management of neonatal jaundiceA problem-orientated case record
Arch Dis Child
Hepatitis syndrome in infancy—An epidemiological survey with 10 year follow-up
Arch Dis Child
Jaundice in babiesImplications for community screening for biliary atresia
Br Med J
Cited by (77)
Laparoscopic common bile duct exploration in infants with inspissated bile syndrome and choledocholithiasis: A case series
2024, Journal of Pediatric Surgery Case ReportsCefotaxime-induced inspissated bile syndrome in a newborn: A case report
2024, Journal of Pediatric Surgery Case ReportsSpontaneous bile duct perforation in a neonate
2018, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Lastly, Moore et al. suggested that SBP seemed to exist on a continuum with choledochal cyst as a form of acquired biliary atresia [7]. This opinion is supported by the observation that SBP seems to occur in children two weeks to five months of age, and perforated choledochal cysts usually present six months to seven years [8,9]. While the presentation of SBP is variable, the most common symptoms are abdominal distension, jaundice, acholic stools, and nonbilious emesis [1].
Inspissated bile syndrome; Safe and effective minimally invasive treatment with percutaneous cholecystostomy in neonates and infants
2016, Journal of Pediatric SurgeryPopulation-based incidence and risk factors for cholestasis in hemolytic disease of the fetus and newborn
2022, Journal of PerinatologyInvestigation of jaundice
2022, Handbook of Pediatric Surgery