A novel approach to the management of late-onset liver failure in biliary atresia
Purpose: Late-onset hyperbilirubinemia in patients who have undergone a successful portoenterostomy (PE) for biliary atresia (BA) is usually considered evidence of ongoing severe liver failure. The authors recently have treated 2 patients who had acute hyperbilirubinemia years and months after a successful PE and had dilated intrahepatic cysts. A combined operative and percutaneous approach reestablished drainage and a reduction in their bilirubin levels.
Methods: Data from 2 cases of BA and late-onset hyperbilirubinemia from obstruction were reviewed and analyzed.
Results: Two patients (15-year-old boy and a 2.5-year-old girl) presented with increasing serum bilirubin after a PE for BA in infancy. Both had extensive preoperative workup, which showed intrahepatic biliary dilatation in one and a large bile lake in the other. They underwent attempted percutaneous transhepatic cholangiography and stenting, followed by an intraoperative transhepatic approach in which the dilated ducts were connected to the PE. A rapid and sustained reduction in the serum bilirubin level was noted in these patients.
Conclusions: When patients with BA after a successful PE present with sudden onset of hyperbilirubinemia, imaging for biliary obstruction should be carried out. If biliary dilatation is found, then a combined radiologic and operative approach may help improve the bile flow and delay the need for liver transplant.
Journal of Pediatric Surgery
Hirschl, R. B.,
Coran, A. G.
(2004). A novel approach to the management of late-onset liver failure in biliary atresia. Journal of Pediatric Surgery, 39(4), 371-374.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/185