Transcript complications after kasai procedure: ascending cholangitis

POST-OPERATIVE COMPLICATIONS
OF BILIARY ATRESIA
HEPATOPORTOENTEROSTOMY
-“Kasai procedure”
- The most effective
surgical treatment to
promote bile flow into
the intestine
Source: Schwartz’s Manual of Surgery
HEPATOPORTOENTEROSTOMY
- A third of patients
remain symptom-free
after the procedure,
but a remainder
require liver
transplantation
because of
progressive liver
failure.
Source: Schwartz’s Manual of Surgery
COMPLICATIONS AFTER KASAI PROCEDURE:
ASCENDING CHOLANGITIS
- Most common complication
- A bacterial infection of the biliary tree
- Bacteria normally found in the small intestine
moves up the Roux-en-Y causing infection.
- It has a strongly negative influence
on prognosis after successful surgical repair,
being the cause of progressive cirrhosis and
death in a considerable number of cases.
Source: http://www.classkids.org/library/biliaryatresia.htm
Case Report: Late Cholangitis After Kasai Procedure Detected with Magnetic Resonance Cholangiopancreaticography. Journal of Pediatric Gastroenterology and Nutrition.
COMPLICATIONS AFTER KASAI PROCEDURE:
Signs of
sepsis
Lighter
stools
Increased
jaundice
ASCENDING
CHOLANGITIS
Intravenous and longterm oral antibiotics
are used to prevent
and treat ascending
cholangitis.
Source: http://www.classkids.org/library/biliaryatresia.htm
COMPLICATIONS AFTER KASAI PROCEDURE:
PORTAL HYPERTENSION
- Formation of scar tissue eventually leads to portal hypertension in many
children.
- Complications of portal hypertension include problems with bleeding and
clotting; enlarged weak veins in the esophagus and stomach; and ascites.
- The most common localisation of the varices are: esophagus, stomach,
Roux en Y loop, rectum.
In case of failed Kasai operation, portal hypertension is treated by
liver transplantation, but often require sclerotherapy or variceal
ligation before liver replacement.
Source: http://www.classkids.org/library/biliaryatresia.htm
http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm
COMPLICATIONS AFTER KASAI PROCEDURE:
INTRAHEPATIC BILIARY CAVITIES
- Large intrahepatic biliary cysts may develop several months
to years after the Kasai operation, even in patients with
complete clearance of jaundice.
- These cavities may become infected and/or compress
portal vein, requiring external drainage.
Cystoenterostomy or liver transplantation may
eventually be required.
Source: http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm
COMPLICATIONS AFTER KASAI PROCEDURE:
POOR GROWTH AND MALNUTRITION
- Adequate bile flow is needed for the
digestion and absorption of dietary fats
and fat-soluble vitamins, including
vitamins A, D, E, and K.
- Hence, when bile flow is reduced, poor
growth and malnutrition may result.
Special formulas containing mediumchain triglycerides (an easily digested
form of dietary fat) and water-soluble
vitamin supplements are often
prescribed to maximize the child’s
growth and development.
Source: http://www.classkids.org/library/biliaryatresia.htm