The evaluation of infant stool color card combined with laparoscopy-assisted cholangiography in diagnosis of prolonged jaundice in infants

Abstract

Objective To evaluate the accuracy of using infant stool color card combined with laparoscopy-assisted cholangiography in diagnosis of prolonged jaundice in infants. Methods Seventytwo infants were admitted for prolonged jaundice. The patients included 38 males and 34 females with an average age of 64 days old. The color of patients' stool was checked using infant stool color card by their parents for at least 7 days. The patients with persistent abnormal stool color or sharply fluctuated stool color were performed laparoscopy-assisted cholangiography and liver histopathological examination. The other infants, whose stool color was normal for more than 7 consecutive days or became normal after medical treatment, received conservative treatments. All children were followed up for 6 to 12 months. The ultrasonography, MRCP and ECT of the 72 infants were studied during follow-up. Results Among the 72 patients, 48 with abnormal stool color underwent laparoscopy-assisted cholangiography and liver histopathological examination. Biliary atresia (BA) was diagnosed in 43 patients. The 14 infants with normal stool color were diagnosed with infant hepatitis syndrome (IHS), underwent medical treatment and all were cured. Among the 10 infants whose stool color sharply fluctuated, 4 infants' stool color turned to normal after medical treatment and were diagnosed with IHS (3 with IHS, the other 1 was finally diagnosed with BA after 6-12 months' follow-up). The other 6 infants underwent laparoscopic exploration and laparoscopic cholecystocholangiography. IHS was diagnosed in 1 case. BA was diagnosed in 3 cases and congenitalbile duct hypoplasia (CBDH) in 2.Only 8 patients (11.1 ％), who were finally diagnosed with IHS, was initially diagnosed with BA and underwent unnecessary laparoscopic exploration and laparoscopic cholecystocholangiography. The sensitivity, specificty and accuracy of using infant stool color card to diagnose BA was 97.9％, 73.9％ and 90.0％ respectively. Conclusions Infant stool color card is accurate to screen BA in infants with prolonged jaundice. It can decrease unnecessary laparoscopic exploration and laparoscopic cholecystocholangiography. Key words: Biliary atresia; Laparoscopy; Cholangiography