Diagnostic Laparoscopy in Infantile Cholestatic Jaundice

When jaundice persists for more than 14 days postnatally, the early diagnosis of surgical jaundice is important for the prognosis in extrahepatic biliary atresia after draining procedure. The role of diagnostic laparoscopy to differenctiate medical causes of jaundice from biliary atresia is evaluated in this report. Four patients with prolonged jaundice have been included in this study. When the gallbladder was not visualized we proceeded to laparotomy. In patients with enlarged gallbladder visualized at laparoscopy, laparoscopic guided cholangiogram was performed, and laparoscopic liver biopsy was done for those who had a patent biliary tree. Two patients had small atretic gallbladder and underwent a Kasai hepato-portoenterostomy. One patients showed a patent gallbladder and common bile duct with atresia of the common hepatic and intrahepatic ducts, and they underwent a Kasai hepatic-portoenterostomy. One patient showed an enlarged gallbladder and laparoscopic-guided cholangiogram were normal. Laparoscopic liver biopsy was performed. There were no complications. Laparoscopy wth laparoscopic-guided cholangiogram may be a valuable method in accurate and earlier diagnosis in an infant with prolonged jaundice.

A Case of Recurrent Perianal Paget's Disease

Extramammary Paget's disease is an uncommon intraepithelial carcinoma of the skin and mucosa usually occurring in the anogenital area. Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. Clinical manifestations of perianal Paget's disease include pruritis (most common), irritation, rash, lump sensation and the lesion shows erythematous, crusted or scaly area which may weep clear fluid. Lichenified, leukokeratotic or leukoplakia-like patches may also develop in some patients. These areas may resemble eczema or contact dermatitis. Many authors recommend surgery as the treatment of choice. Extended surgical excision for non-invasive lesion and excision of rectum or abdominoperineal resection for invasive disease is recommended. The prognosis for non-invasive lesion is excellent, but for invasive lesion is poor.We experienced one case of perianal Paget's disease which recurred after wide excision of vulvar area for Paget's disase, and performed secondary abdominoperineal resection. Now, radiation therapy was done for adjuvant therapeutic modality.