An alternate method for intraoperative cholangiography in infants with severe obstructive jaundice.

Differentiation between biliary atresia, biliary hypoplasia and severe neonatal hepatitis continues to require direct visualization of the biliary ducts. This is usually accomplished by operative cholangiography using radiographic contrast material. Recently, we have employed an alternate technique of operative cholangiography using methylene blue. This method identifies patent biliary ducts by direct visualization. Methylene blue cholangiography (MBC) has been used in 16 infants with severe obstructive jaundice. In contrast to the radiopaque cholangiogram, MBC more accurately demonstrated biliary hypoplasia in two patients. In addition to the better resolution obtained by MBC, it can be performed in considerably less time than that usually required for x-ray cholangiography.