Abstract
A series of 32 infants with persistant jaundice in whom an unequivocal differentiation between intrahepatic cholestasis and biliary atresia could not be made is reviewed. A protocol including Lipoprotein-X (LP-X) determinations before and after a short course of cholestyramine (CSM) was carried out in all. A fall in serum LP-X after CSM indicates the presence of patent extrahepatic bile ducts (even microscopic) which will function without benefit of hepatic portoenterostomy. A rise in LP-X levels after CSM means an atretic biliary system. The LP-X, CSM protocol was not able to differentiate between the anatomical variants of biliary atresia that may respond to hepatic portoenterostomy and those that will not. Patent bile ducts (even microscopic) in the porta hepatis and/or proximal hepatoduodenal ligament, which are in continuity with intrahepatic ducts, must be present if hepatic portoenterostomy is to be successful. None of our 12 infants undergoing hepatic portoenterostomy showed evidence of bile excretion after the procedure. Microscopic study of serial sections taken through the excised hepatoduodenal ligament tissues of these 12 infants revealed that none had anatomical findings conducive to the success of the operation.
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- Campbell D. P. Hepatic portoenterostomy. Indicated or not in the treatment of biliary atresia? Am J Dis Child. 1975 Dec;129(12):1427–1428. doi: 10.1001/archpedi.1975.02120490039012. [DOI] [PubMed] [Google Scholar]
- Campbell D. P., Poley J. R., Alaupovic P. Determination of serum lipoprotein-X for the early differentiation between neonatal hepatitis and biliary atresia. J Surg Res. 1975 Apr;18(4):385–390. doi: 10.1016/0022-4804(75)90098-0. [DOI] [PubMed] [Google Scholar]
- Campbell D. P., Poley J. R., Alaupovic P., Smith E. I. The differential diagnosis of neonatal hepatitis and biliary atresia. J Pediatr Surg. 1974 Oct;9(5):699–705. doi: 10.1016/0022-3468(74)90108-0. [DOI] [PubMed] [Google Scholar]
- Campbell D. P., Poley J. R., Bhatia M., Smith E. I. Hepatic portoenterostomy--is it indicated in the treatment of biliary atresia? J Pediatr Surg. 1974 Jun;9(3):329–333. doi: 10.1016/s0022-3468(74)80288-5. [DOI] [PubMed] [Google Scholar]
- Campbell D. P., Smith E. I., Bhatia M., Poley J. R., Williams G. R. Hepatic portoenterostomy: an assessment of its value in the treatment of biliary atresia. Ann Surg. 1975 May;181(5):591–595. doi: 10.1097/00000658-197505000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Greim H., Trülzsch D., Czygan P., Rudick J., Hutterer F., Schaffner F., Popper H. Mechanism of cholestasis. 6. Bile acids in human livers with or without biliary obstruction. Gastroenterology. 1972 Nov;63(5):846–850. [PubMed] [Google Scholar]
- HAYS D. M., SNYDER W. H., Jr LIFE-SPAN IN UNTREATED BILIARY ATRESIA. Surgery. 1963 Aug;54:373–375. [PubMed] [Google Scholar]
- Kasai M. Treatment of biliary atresia with special reference to hepatic porto-enterostomy and its modifications. Prog Pediatr Surg. 1974;6:5–52. [PubMed] [Google Scholar]
- Lilly J. R., Altman R. P. Hepatic portoenterostomy (the Kasai operation) for biliary atresia. Surgery. 1975 Jul;78(1):76–86. [PubMed] [Google Scholar]
- Magnani H. N., Alaupović P. A method for the quantitative determination of the abnormal lipoprotein (LP X) of obstructive jaundice. Clin Chim Acta. 1972 May;38(2):405–411. doi: 10.1016/0009-8981(72)90132-5. [DOI] [PubMed] [Google Scholar]
- Poley J. R., Smith E. I., Boon D. J., Bhatia M., Smith C. W., Thompson J. B. Lipoprotein-X and the double 131 I-rose bengal test in the diagnosis of prolonged infantile jaundice. J Pediatr Surg. 1972 Dec;7(6):660–669. doi: 10.1016/0022-3468(72)90276-x. [DOI] [PubMed] [Google Scholar]