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Percutaneous transhepatic cholangiodrainage after hepatic portoenterostomy for biliary atresia
Insights
Percutaneous transhepatic cholangiodrainage (PTCD) aids in visualizing and managing biliary atresia complications in infants post-surgery. This technique is valuable for bile collection, antibiotic delivery, and relieving cholestasis.
Area of Science:
- Pediatric Surgery
- Hepatology
- Interventional Radiology
Background:
- Biliary atresia requires surgical reconstruction like hepatic portoenterostomy.
- Post-operative complications include cholangitis and cholestasis.
- Percutaneous transhepatic cholangiodrainage (PTCD) is an interventional technique.
Observation:
- PTCD was performed on 9 infants following biliary atresia surgery.
- Cholangiograms successfully visualized the intrahepatic biliary system in all cases.
- Intrahepatic bile cultures revealed enteric flora in infants with cholangitis.
Findings:
- PTCD was technically successful in 5 infants (9 procedures).
- Direct antibiotic administration via PTCD showed transient efficacy for cholangitis.
- Continuous PTCD for three weeks reduced serum bilirubin by relieving cholestasis.
Implications:
- PTCD is useful for demonstrating reconstructed biliary systems.
- It facilitates bile collection for diagnostic studies.
- PTCD enables targeted antibiotic delivery and biliary decompression, aiding in managing post-surgical complications in biliary atresia.
Abstract:
During the past 12 mo, percutaneous transhepatic cholangiodrainage (PTCD) was carried out in 9 infants (12 procedures) who had undergone hepatic portoenterostomy (8) and hepatic portocholecystostomy (1) for biliary atresia. Bile excretion following surgery was observed in all infants. In all patients, cholangiogram at the initiation of PTCD was successful in visualizing the intrahepatic biliary system. PTCD was achieved in 5 infants (9 procedures). In infants with cholangitis, cultures of the intrahepatic bile were positive for enteric flora. Direct administration of antibiotics via the PTCD catheter into the bile ducts was transiently effective in the management of cholangitis. In one patient, it was observed that continuous PTCD over three weeks was effective in reducing serum bilirubin by relief of cholestasis. This technique is useful for: (1) demonstration of the reconstructed biliary system, (2) collection of bile from the intrahepatic biliary system for biochemical and bacteriologic studies, (3) direct administration of antibiotics to the bile ducts for cholangitis and (4) decompression of the intrahepatic system and relief of biliary stasis.