S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) The Seoul Journal of Medicine The Seoul Journal of Medicine Vol. 34 No.4 (1993)
Clinical Significance of Duodenal Bile Acids in Differential Diagnosis for Infantile Jaundice -Duodenal Intubation in Infants with Cholestatic Jaundice-
- Sim, Jae Geon; Seo, Jeong Kee
- Issue Date
- Seoul J Med, Vol.34 No.4, pp. 279-284
- Bile acid; Biliary atresia; Duodenal intubation; Duodenal fluid; DISIDA scan; Neonatal cholestasis
- We evaluated the effectiveness of bile in duodenal fluid collected by intubation
from neonates with severe cholestasis to differentiate biliary atresia. Eighty five
infants with cholestatic jaundice and acholic stools were studied prospectively from
November 1985 to July 1992. Forty nine patients had biliary atresia, 34 neonatal hepatitis,
and 2 intrahepatic bile duct paucity. Almost all (47 of 49 infants) of the biliary
atresia patients did not show bile in the duodenal fluid and most of the neonatal hepatitis
cases (29 of 34 patients) revealed bile in the juice, whereas only 8 of 32 neonatal
hepatitis patients demonstrated bowel radio-activity on DISIDA scan. Seventy six of 85
cholestatic jaundice patients could be diagnosed correctly by duodenal intubation bile
study, and only 8 of 83 patients could be diagnosed by DISIDA scan only in this study.
When DISIDA and duodenal intubation were carried out simultaneously, we could confirm
the correct diagnosis in 77 of 83 patients before liver biopsy and operative
cholangiogram. During the study, intubation did not cause any complication at all.
These data suggest that duodenal intubation must be a superior method for the differentiation
of cholestatic jaundice patients, and, moreover, it is simple, rapid and cheap.