Related Experiment Videos
Inguinal hernias associated with biliary atresia
1Department of Paediatric Surgery, King's College Hospital, London, United Kingdom. a.zani@ich.ucl.ac.uk
Insights
Infants with biliary atresia (BA) have a higher incidence of inguinal hernias, likely due to liver fibrosis and increased abdominal pressure. This finding suggests a link between liver disease severity and hernia development in BA patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) in infants can lead to hepatic fibrosis and ascites.
- Ascites in BA patients may increase the risk of developing inguinal hernias.
Purpose of the Study:
- To investigate the incidence of inguinal hernias in infants diagnosed with biliary atresia.
- To explore potential correlations between inguinal hernias and clinical factors in BA infants.
Main Methods:
- Retrospective review of biliary atresia (BA) infants diagnosed between 2006 and 2010 at a single center.
- Comparison of BA infants with inguinal hernias versus those without, analyzing clinical data and outcomes.
- Statistical analysis using nonparametric tests with significance set at p ≤ 0.05.
Main Results:
- 10 out of 123 (8.1%) infants with BA developed inguinal hernias.
- No significant differences were found in age at Kasai portoenterostomy, cytomegalovirus status, corticosteroid use, or need for liver transplant.
- Infants with inguinal hernias showed a higher aspartate aminotransferase-to-platelet ratio, indicating more severe liver fibrosis (p = 0.02).
Conclusions:
- Biliary atresia infants exhibit a high incidence of inguinal hernias.
- The occurrence of inguinal hernias appears associated with the degree of liver fibrosis and likely ascites and intra-abdominal pressure in BA infants.
- This study is the first to report this association, highlighting a potential complication of BA related to liver disease severity.
Introduction:
Infants with biliary atresia (BA) develop a degree of hepatic fibrosis as a consequence of their cholangiopathy. Some of them present clinically evident ascites that might predispose to inguinal hernias. We aimed to investigate whether infants with BA have a higher incidence of inguinal hernias.
Methods:
Single-center retrospective review of all BA infants diagnosed between January 2006 and December 2010. Infants with a clinical diagnosis of inguinal hernia were identified and compared with those without. Data were expressed as median (range) and compared with nonparametric statistical tests. p ≤ 0.05 was regarded as significant.
Results:
A total of 123 infants underwent Kasai portoenterostomy (KP) during the period. Of these, 10 (8.1%) infants (7 boys) developed inguinal hernias (bilateral n = 4, right n = 5, left n = 1); 9 were repaired (at KP [n = 3] and post-KP [n = 6] at 15 [7 to 30] days) using nonabsorbable sutures, and 1 died before repair. There was no difference in median age at KP (66 vs. 58 days, p = 0.31); cytomegalovirus (IgM positive) status (p = 1.0); use of postoperative corticosteroids (p = 0.49); or ultimate need for liver transplant (p = 1.0). However, aspartate aminotransferase-to-platelet ratio (surrogate marker of liver fibrosis) was higher in hernia infants (2.0 vs. 1.0; p = 0.02). Recurrence has not been identified at a follow-up of 27 months (4 to 55).
Conclusions:
This is the first report to suggest that BA infants have a high incidence of inguinal hernias, which seems related to degree of liver fibrosis at presentation and presumably degree of ascites and increased intra-abdominal pressure.
Related Concept Videos
01:25Hiatal Hernia
01:19Appendicitis
01:18Veins of the Abdomen and Pelvis
The inferior vena cava is fed by numerous smaller veins. The lumbar veins, for instance, drain the posterior abdominal wall, emptying both directly into the inferior vena cava and into the...