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Biliary Obstruction Associated with Icterus Gravis Neonatorum

1946; BMJ; Volume: 21; Issue: 108 Linguagem: Inglês

10.1136/adc.21.108.209

1468-2044

Reginald Lightwood, Martin Bodian,

Pediatric Urology and Nephrology Studies

Great Ormond StreetFor twenty years it has been known that obstruc- tive jaundice may occasionally be seen in icterus gravis neonatorum.Still (1927) quoted the view that the bile of excessive haemolysis becomes too viscid to pass freely along the ducts, and he mentions the low pressure at which it is secreted.This view does not altogether explain the facts, because a marked obstructive phase does not necessarily go with the greatest haemolysis or the deepest preced- ing jaundice.MacClure (1931) suggested that the presence of a foreign substance in the bile caused coagulation in the bile capillaries.We favour a third possibility-namely, that biliary obstruction is due to swelling of damaged hepatic cells-because histological studies of icterus gravis show that such an association exists.The association is seen also in conditions other than icterus gavis, for example, stagnation of bile may be seen just outside areas of maximal necrosis in infective hepatitis.Skelton and Tovey (1945) postulate two forms of biliary obstrution in association with icterus gravis: (a) blockag of one of the larger bile ducts with in- spissated bile; and (b) conversion of the bile ducts into a fibrous cord.First let us consider the latter, that is, atresia of the bile ducts associated with icterus gravi Blary Arsia Associatedwith Icteru Gravis Neonatorum Pasachoff (1935) reported the case, fatal at the age of five days, of a coloured girl who some twelve hours after birth had deep jaundice, hepatospleno- mgaly, and erythroblastosis, yet no anaemia On the fourth day haemorrhage appared and the stools were white.A moderate degree of anaemia developed.Necropsy showed extensive extra- medullary haematopoiesis, kernlterus, complete atrsia of the bile ducts, and c ral aplasia.This case was reported in the pre-Rh period, and, there- fore, the diagnosis of icterus gravis, though probably correct, could not be established beyond all doubt.CoCEwrr.We tlhink that in this case no final proof of the aiation of the two conditions has 209 copyright.