Sir.—The report by Traynelis and Hrabovsky1 concluded that the treatment of "acute cholecystitis" in the neonate is surgery. They based this conclusion on their description of a single patient whose palpable gallbladder was diagnosed by ultrasound to have sludging, was noted to function poorly on a technetium Tc 99m paraisopropyl iminodiacetic acid (PIPIDA) scan, and turned out to show histologic signs of "chronic cholecystitis" after its removal. Aside from an enlarged gallbladder and neonatal jaundice, this patient had no signs of infection or biliary tract disease. Between diagnosis and surgery, the mass in the right upper quadrant of the abdomen decreased in size, and the serum bilirubin level fell. The authors cited a total of nine other cases reported in the world literature, all but one treated surgically, and a "20% mortality rate" to buttress their recommendation for surgery.
We strongly disagree with this recommendation. When performing abdominal