Refractory cholangitis after Kasai's operation caused by candidiasis: a case report

Area of Science:

• Hepatology
• Pediatric Surgery
• Medical Mycology

Background:

• Biliary atresia is a rare congenital condition in infants, causing bile duct obstruction.
• Kasai portoenterostomy is a surgical procedure to treat biliary atresia.
• Recurrent cholangitis is a common complication following Kasai portoenterostomy.

Observation:

• A patient with biliary atresia, previously treated with Kasai portoenterostomy, presented with refractory cholangitis.
• Re-exploration revealed granulation tissue obstructing the porta hepatis.
• Microscopic examination of the obstructing tissue identified pseudohyphae of Candida albicans.

Findings:

• The granulation tissue obstructing the porta hepatis was confirmed to be a fungal infection (Candida albicans).
• Local irrigation with Amphotericin B, an antifungal medication, was administered.
• The patient's condition improved, becoming afebrile (fever-free) and anicteric (jaundice-free) after treatment.

Implications:

• This case highlights a rare but significant cause of post-surgical biliary obstruction in pediatric patients.
• Fungal infections, specifically Candida albicans, should be considered in refractory cholangitis cases after Kasai portoenterostomy.
• Antifungal therapy can be effective in managing fungal-induced biliary obstruction.