A 5-week-old term infant has persistent jaundice since the second week of life. Stools are pale clay coloured, urine stains the nappy dark yellow, and the liver is firm. Fractionated bilirubin shows a predominantly conjugated pattern. Which management decision offers this child the best chance of native liver survival?
- A Ursodeoxycholic acid trial for 3 months before considering surgery
- B Cholecystojejunostomy for internal drainage
- C Hepatoportoenterostomy performed before 60 days of age ✓
- D Liver transplantation listed immediately, surgery deferred until 6 months
Correct answer: C. Hepatoportoenterostomy performed before 60 days of age
Explanation
Conjugated jaundice beyond 14 days of life with acholic stools and dark urine indicates biliary atresia until proven otherwise. Kasai hepatoportoenterostomy is the initial operation, and its success falls sharply with delay: outcomes are clearly better when it is done before 60 days, and poor beyond 90 to 100 days. Cholecystojejunostomy fails because the entire extrahepatic biliary tree, including the gallbladder, is fibrotic and non-draining.
Reference: Ashcraft's Pediatric Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.