[Bile lake post Kasai hepatoportoenterostomy in biliary atresia]
Insights
This case report details a boy with extrahepatic biliary atresia experiencing recurrent cholangitis due to bile lakes post-Kasai hepatoportoenterostomy. Interventions like bile lake drainage successfully managed infection, improving quality of life.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Extrahepatic biliary atresia requires surgical correction, often via Kasai hepatoportoenterostomy.
- Postoperative complications include recurrent cholangitis and biliary drainage issues.
- Bile lakes can form in the liver hilum after Kasai procedures.
Observation:
- A pediatric patient presented with recurrent cholangitis and fever after Kasai hepatoportoenterostomy.
- Imaging revealed bile lakes, and bile aspirate culture identified multiresistant Klebsiella.
- Fever and anemia recurred after initial antibiotic treatment cessation.
Findings:
- Refashioning the portoenterostomy improved biliary drainage.
- Drainage of bile lakes combined with parenteral antibiotics controlled severe cholangitis and associated anemia.
- Symptomatic improvement was sustained with ongoing bile lake drainage.
Implications:
- Bile lakes post-Kasai procedure are associated with increased cholangitis risk.
- While conservative management is common, aggressive interventions like drainage may be necessary.
- Individualized treatment balancing quality of life and transplant delay is crucial.
Abstract:
In this case report we describe a boy with extrahepatic biliary atresia who underwent a Kasai hepatoportoenterostomy at six weeks of age. Beginning several weeks post-op, he had recurrent cholangitis inadequately controlled by various antibiotic prophylaxis regimens. Imaging revealed the development of several bile lakes in the liver hilum. Due to the recurrent nature of his cholangitis, and some evidence of acutely impaired biliary drainage, he underwent a refashioning of his portoenterostomy with resultant improved drainage. However, shortly thereafter, the patient developed ongoing fever and anemia. Culture of the bile lake aspirate grew multiresistant Klebsiella and a 6 week course of parenteral meropenume controlled his fever and his anemia improved. Following treatment cessation his fever and anemia returned. A biliary drain was inserted into his larger bile lake and following another course of parenteral antibiotics he has remained free of clinically detected cholangitis despite ongoing contamination of drained bile fluid. The development of bile lakes after Kasai hepatoportoenterostomy is not an uncommon finding. This have been associated with worse prognosis including increased incidence of cholangitis. Often, conservative treatment with prophylactic antibiotics suffices, however, in rare cases, more aggressive intervention may be considered including percutaneous bile drainage or surgical management. The benefit of these management strategies must be balanced with the potential gain regarding quality of life and delaying transplant, on an individual basis.
