The most common causes of neonatal cholestasis are neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA). Since neonatal cholestasis presents with variable expression of same pathologic process and has similar clinical, biochemical, and histologic features between EHBA and idiopathic neonatal hepatitis (NH), differential diagnosis is often difficult. We reviewed the differences of clinical characteristics and laboratory data to find out any correlation between the results of Tc^99m DISIDA scan and presence of acholic stool.

Between June 1993 and January 2001, total 29 infants younger than 4 month-old underwent Tc^99m DISIDA scan. Their biochemical tests and clinical course were reviewed retrospectively.

Patients who had negative intestinal activity on Tc^99m DISIDA scan showed acholic stool and revealed higher serum direct bilirubin and urine bilirubin level. 18.2% of patients with acholic stool showed intestinal activity on Tc^99m DISIDA scan and 81.8% of them did not. All the patients without acholic stool showed positive intestinal activity on Tc^99m DISIDA scan. The result of Tc^99m DISIDA scan and the presence of acholic stool showed high negative correlation (r :-0.858). Patients with acholic stool and negative intestinal activity on Tc^99m DISIDA scan showed higher serum total bilirubin level. Patients without acholic stool and positive intestinal activity on Tc^99m DISIDA scan showed higher serum level of ALT.

Patients with acholic stool and negative intestinal activity showed high correlation, but 18.2% of patients with acholic stool showed positive intestinal activity. So operative cholangiogram or transcutaneous liver biopsy should be performed for confirmation.