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Inflammatory stenosis of the whole extrahepatic bile duct in a child: a case report
Insights
This case study details a child with prolonged obstructive jaundice treated with Y-hepaticojejunostomy. The successful surgery led to long-term improvement, suggesting an abortive biliary atresia form.
Area of Science:
- Pediatric surgery
- Hepatology
- Gastroenterology
Background:
- Obstructive jaundice in children requires timely surgical intervention.
- Biliary atresia is a progressive condition affecting bile ducts.
- Severe periductal fibrosis presents surgical challenges.
Observation:
- A 5-year-old female presented with longstanding obstructive jaundice and hepatic dysfunction since 6 months of age.
- The patient underwent Roux-en-Y hepaticojejunostomy for severe extrahepatic ductal fibrosis.
- Initial postoperative bile drainage was good, but jaundice and ascites resolved over two years.
Findings:
- Liver biopsy revealed biliary cirrhosis with ductal proliferation.
- The patient, now 13, shows moderately impaired liver function but is clinically stable.
- Endoscopic evaluation showed no recent esophageal varices.
Implications:
- This case suggests an abortive form of biliary atresia.
- Surgical intervention can lead to long-term improvement even in advanced cases.
- Early diagnosis and management are crucial for pediatric obstructive jaundice.
Abstract:
A female child, 5 years and 5 months of age, who had had longstanding obstructive jaundice with hepatic dysfunction from the age of 6 months, underwent Y-hepaticojejunostomy according to Roux after dissection of the entire extrahepatic duct with severe periductal fibrosis. At that time, liver biopsy already showed progress to biliary cirrhosis with prominent ductal proliferation in Glisson's triad. Although good bile drainage to the intestine was obtained early after the operation, 2 years elapsed until disappearance of jaundice and ascites with improvement of liver function. The patient is now 13 years old and doing well with moderately impaired liver function. No oesophageal varices have been seen by endoscopy lately. The clinical course and data are suggestive of an abortive form of biliary atresia.