Related Experiment Videos
[Portal hypertension and biliary atresia (author's transl)]
Insights
Portal hypertension is common in biliary atresia, often appearing before 3 months. Successful hepatoportoenterostomy significantly reduces the risk of esophageal varices bleeding, making shunts rarely necessary.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Context:
- Biliary atresia is a severe neonatal liver disease.
- Portal hypertension is a known complication.
- Surgical management aims to restore bile flow and prevent liver damage.
Purpose:
- To investigate the prevalence and clinical significance of portal hypertension in children with biliary atresia.
- To assess the risk of esophageal varices and bleeding.
- To evaluate the outcomes of surgical interventions, including shunts.
Summary:
- Portal hypertension was detected in 61.8% of 260 children with biliary atresia before 3 months of age.
- Esophageal varices were observed in 14 children, with bleeding occurring in 6 cases, primarily those with recurrent jaundice or biliary retention.
- Surgical shunts had mixed results, with 5 of 7 patients experiencing functional success, while others faced complications or rebleeding.
Impact:
- Early detection and management of portal hypertension are crucial in biliary atresia.
- Successful hepatoportoenterostomy appears to mitigate the risk of variceal bleeding, even with persistent liver fibrosis.
- This suggests a reduced need for portocaval shunts in effectively treated biliary atresia cases.
Abstract:
The study of portal pressure during surgical exploration for biliary atresia in the series of 260 children operated at the Hospital Saint-Vincent de Paul since 1968 showed that portal hypertension could be demonstrated in 61.8% of the cases before the age of 3 months. Among the 54 children surviving without jaundice, splenomegaly was found in 35 cases; esophageal varices were seen in 14 children, more frequently after 5 years of age. Bleeding from esophageal varices occurred only in cases with recurrence of jaundice or moderate biliary retention, i.e. for 6 children. A portocaval shunt was constructed in 7 cases; all had bled except one. One child died two and a half years later from pneumococcal sepsis after a splenorenal shunt with splenectomy; another child had numerous recurrence of bleeding episodes. Five children have a functional shunt and have not rebled. When biliary atresia is cured by hepatoportoenterostomy, with complete disappearance of biliary retention, the risk of bleeding from esophageal varices is unlikely, in spite of persistent cirrhotic alterations of the liver; in these children, there should very seldom be an indication for a portocaval shunt.