Bile duct lavage and cholecystectomy

Abstract

A 90-day-old infant with inspissated bile syndrome unresponsive to medical management is presented. The infant was born premature, low birth weight (1600 g) at 28 weeks, became jaundice few days after birth. He received neonatal intensive care therapy for 4 weeks. Investigations on admission revealed conjugated hyperbilirubinemia (total bilirubin – 8.26 mg/dl). Abdominal ultrasound and magnetic resonance cholangiopancreatography were suggestive of biliary atresia with nonvisualization of the gallbladder and common bile duct (CBD). Intraoperatively, cholecystotomy confirmed the presence of bile; placement of infant feeding tube in the infundibulum with saline irrigation confirmed CBD obstruction. After multiple gentle attempts with saline lavage, distal clearance was achieved, suggested by duodenal filling up with saline and by nasogastric aspiration. The patient passed colored (bile containing) stools with bile plugs on the 5th postoperative day. Bilirubin values returned to normal, and the outcome was favorable.