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Surgery for Neonatal Acalculous Cholecystitis

Surgery for Neonatal Acalculous Cholecystitis Abstract Sir.—The report by Traynelis and Hrabovsky1 concluded that the treatment of "acute cholecystitis" in the neonate is surgery. They based this conclusion on their description of a single patient whose palpable gallbladder was diagnosed by ultrasound to have sludging, was noted to function poorly on a technetium Tc 99m paraisopropyl iminodiacetic acid (PIPIDA) scan, and turned out to show histologic signs of "chronic cholecystitis" after its removal. Aside from an enlarged gallbladder and neonatal jaundice, this patient had no signs of infection or biliary tract disease. Between diagnosis and surgery, the mass in the right upper quadrant of the abdomen decreased in size, and the serum bilirubin level fell. The authors cited a total of nine other cases reported in the world literature, all but one treated surgically, and a "20% mortality rate" to buttress their recommendation for surgery. We strongly disagree with this recommendation. When performing abdominal References 1. Traynelis VC, Hrabovsky EE: Acalculous cholecystitis in the neonate . AJDC 1985;139: 893-895. 2. Keller MS, Markle BM, Laffey PA, et al: Spontaneous resolution of cholelithiasis in infants . Radiology 1985;157:345-348.Crossref 3. Faller W, Berkelhamer JE, Esterly JR: Neonatal biliary tract infection coincident with maternal methadone therapy . Pediatrics 1971;48: 997-998. 4. Ternberg JL, Keating JP: Acute acalculous cholecystitis in childhood . Arch Surg 1975;110: 543-547.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140210017011
Publisher site
See Article on Publisher Site

Abstract

Abstract Sir.—The report by Traynelis and Hrabovsky1 concluded that the treatment of "acute cholecystitis" in the neonate is surgery. They based this conclusion on their description of a single patient whose palpable gallbladder was diagnosed by ultrasound to have sludging, was noted to function poorly on a technetium Tc 99m paraisopropyl iminodiacetic acid (PIPIDA) scan, and turned out to show histologic signs of "chronic cholecystitis" after its removal. Aside from an enlarged gallbladder and neonatal jaundice, this patient had no signs of infection or biliary tract disease. Between diagnosis and surgery, the mass in the right upper quadrant of the abdomen decreased in size, and the serum bilirubin level fell. The authors cited a total of nine other cases reported in the world literature, all but one treated surgically, and a "20% mortality rate" to buttress their recommendation for surgery. We strongly disagree with this recommendation. When performing abdominal References 1. Traynelis VC, Hrabovsky EE: Acalculous cholecystitis in the neonate . AJDC 1985;139: 893-895. 2. Keller MS, Markle BM, Laffey PA, et al: Spontaneous resolution of cholelithiasis in infants . Radiology 1985;157:345-348.Crossref 3. Faller W, Berkelhamer JE, Esterly JR: Neonatal biliary tract infection coincident with maternal methadone therapy . Pediatrics 1971;48: 997-998. 4. Ternberg JL, Keating JP: Acute acalculous cholecystitis in childhood . Arch Surg 1975;110: 543-547.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jul 1, 1986

References