[Bone changes in congenital biliary atresia--review of 42 cases after surgery]

Plain radiographs of forty-two infants with biliary atresia were reviewed to clarify the clinical significance of bone changes after surgery. The same surgical procedures (hepatoportojejunostomy with Suruga II enterostomy or choledochojejunostomy with Suruga II enterostomy) were performed in all cases except one at Juntendo University Hospital during 1977-1983. Bone changes were found in thirty-one patients during the 2 year period after surgery, and generalized osteopenia was the common radiological manifestation. In addition, sixteen patients were revealed to have rickets and/or fractures. The age of development of osteopenia ranged widely, but that of rickets and fractures ranged from 6 months to 2 years. It corresponded well to the age of recovering from physiological depression of bone mineral content in normal infants. Most rickets and fractures developed in association with other complications such as pulmonary infections. They were healed with treatment within 2-3 months after onset. But osteopenia persisted longer in most cases. Compared to cases without bone changes, jaundice was seen more frequently and the prognoses was worse in cases with bone changes. There was no relationship between rickets or fractures and prognosis. Biochemical data at the onset of bone changes included hypoalbuminemia and hypophosphatemia. Hypoalbuminemia, hypophosphatemia and hypocalcemia were seen in cases with rickets or fractures. But hypocalcemia was improved with treatment. From these observations, we considered that osteopenia reflected well the patients' general condition and prognosis, but most rickets or fractures which developed due to failure to meet the physiological high demand of calcium, did not play a major role for prognosis of biliary atresia.