Clinical Course of Obstructive Jaundice Associated with Operated Meconium Peritonitis in Neonates

Abstract

Background/Purpose: 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).

Patients and 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.

Key words

meconium peritonitis - jaundice - biliary atresia - complication - cholestasis

References

• 1 Agrons GA, Corse WR, Markowitz RI. et al . Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation.  Radiographics. 1996;  16 871-893
• 2 Alvaro D, Gigliozzi A, Marucci L. et al . Corticosteroids modulate the secretory processes of the rat intrahepatic biliary epithelium.  Gastroenterology. 2002;  122 1058-1069
• 3 Aspirot A, Su W, Flageole H. et al . Cholestasis associated with small bowel atresia: do we always need to investigate?.  J Pediatr Surg. 2007;  42 873-877
• 4 Boix-Ochoa J, Lloret J. Meconium peritonitis.. In: Puri P (ed.). Newborn Surgery. 2nd edn. London: Arnold Press; 2003: 471-477
• 5 Chan KL, Tang MH, Tse HY. et al . Meconium peritonitis: prenatal diagnosis, postnatal management and outcome.  Prenat Diagn. 2005;  25 676-682
• 6 Chung MY, Ko TY, Huang CB. et al . Biliary atresia associated with meconium peritonitis.  Chang Gung Med J. 2006;  29 203-206
• 7 Gupta DK, Charles AR, Srinivas M. et al . Betamethasone in plus phenobarbitone prior to hepatobiliary scintigraphy increases diagnostic accuracy in infants with jaundice.  Indian J Pediatr. 2001;  68 1039-1041
• 8 Hamada T, Hirose R, Kosaka T. et al . Giant cystic meconium peritonitis associated with a cloacal anomaly: case report.  J Pediatr Surg. 2008;  43 E21-E23
• 9 Han SJ, Han A, Choi SH. et al . Biliary atresia associated with meconium peritonitis caused by perforation of small bowel atresia.  J Pediatr Surg. 2001;  36 1390-1393
• 10 Lorimer Jr WS, Ellis DG. Meconium peritonitis.  Surgery. 1966;  60 470-475
• 11 Moss RL, Amii LA. New approaches to understanding the etiology and treatment of total parenteral nutrition-associated cholestasis.  Semin Pediatr Surg. 1999;  8 140-147
• 12 Nam SH, Kim SC, Kim DY. et al . Experience with meconium peritonitis.  J Pediatr Surg. 2007;  42 1822-1825
• 13 Sherlock S, Dooley J. Cholestasis.. In: Sherlock S (ed.). Liver and Hepatobiliary Diseases. 11th edn. Oxford: Blackwell; 2002: 219-240
• 14 Shono T, Taguchi T, Suita S. et al . Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis.  J Pediatr Surg. 2007;  42 681-684

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