The diagnostic aids used in dealing with biliary disease in adults were applied to the study in infants of the principal congenital anomalies of the biliary tract such as choledochal cyst, biliary atresia and biliary stenosis. Choledochal cysts were distinguished from other upper abdominal masses occurring in childhood by the use of intravenous cholecystography. Since the clinical manifestations in infants with biliary atresia or stenosis are almost identical to those associated with the obstructive phase of neonatal hepatitis, the problem of differentiation is difficult. The serial total serum bilirubin curve, a careful analysis of the pigment content of feces and urine and duodenal intubation for bilirubin determinations were found to be useful in making the distinction. Operative cholangiograms were helpful in some cases. Frozen section examinations of liver tissue during operation were of little value except to demonstrate certain unusual cases of intrahepatic biliary atresia. Routine liver function studies, including serum transaminase determination in a limited number of cases, did not help in differentiation.

Biliary Atresia↗

PubMed1957

Problems in diagnosis associated with obstructive neonatal jaundice.

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Child↗

PubMed1957

Experience with intravenous cholecystography in infants and children.

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Child↗

PubMed1956

Congenital aganglionic megacolon.

Twenty-one pull-through procedures for congenital aganglionic megacolon (Hirschsprung's disease) have been performed at the Los Angeles Children's Hospital since the adoption of the etiological concept of a distal aganglionic segment in 1949. In 14 cases the Swenson procedure as modified by Hiatt was employed, with perineal excision of the colon segment. There were four postoperative deaths and three symptomatic recurrences in this group. Three patients were treated by transabdominal resection of colon and rectum with subsequent pull-through reconstruction (Swenson). Anterior resection (State) was carried out in two cases. Three children with recurrence of symptoms following primary operation were subjected to a secondary pull-through procedure with an eventual successful outcome. The major portion of the postoperative mortality (29 per cent) in this group occurred in infants less than six months of age in whom anastomotic disruption or proximal segment infarction occurred after operation.A study of 31 cases of congenital aganglionic megacolon in very young infants drew attention to the difficulty of establishing a diagnosis in this age group even at exploratory laparotomy. Among these infants the mortality rate was excessive, regardless of the form of therapy employed. Colostomy appeared to be the indicated surgical procedure if a conservative regimen failed to control intractable colonic obstruction during the first year of life.

Child↗