Skip to main content
SpringerLink
Log in

Current concept about postoperative cholangitis in biliary atresia

  • Review Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

Postoperative cholangitis characterized by fever and acholic stool and positive blood culture is a common and serious complication following Kasai’s operation for biliary atresia. The aim of this review was to describe the pathogenesis, clinical manifestations, medical treatment and outcome of postoperative cholangitis.

Data sources

Articles on biliary atresia retrieved from Pubmed and MEDLINE in the recent 10 years were reviewed.

Results

The pathogenesis of postoperative cholangitis is still controversial. Recent methods for the diagnosis of postoperative cholangitis include urinary sulfated bile acids (USBA) and magnetic resonance cholangiopancreaticography (MRCP). High-dose steroids and oral antibiotics have been used to reduce the incidence of postoperative cholangitis, and recurrent cholangitis leads to a lower survival rate.

Conclusions

Cholangitis is one of the most important determinants of long-term survival after the Kasai’s procedure. The knowledge on postoperative cholangitis has been increasing in the past 10 years, showing a lower incidence of the disease and better therapeutic results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ernest van Heurn LW, Saing H, Tam PK. Cholangitis after hepatic portoenterostomy for biliary atresia: a multivariate analysis of risk factors. J Pediatr 2003;142:566–571.

    Article  PubMed  CAS  Google Scholar 

  2. Wu ET, Chen HL, Ni YH, Lee PI, Hsu HY, Lai HS, et al. Bacterial cholangitis in patients with biliary atresia: impact on short-term outcome. Pediatr Surg Int 2001;17:390–395.

    Article  PubMed  CAS  Google Scholar 

  3. Hsieh CS, Huang LT, Huang CC, Wu JJ, Chuang JH. Bacteria ascend to liver from the bilioenteric conduit after choledochojejunostomy in the cholestatic rat. Pediatr Surg Int 2003;19:699–702.

    Article  PubMed  CAS  Google Scholar 

  4. Chuang JH, Lee SY, Chen WJ, Hsieh CS, Chang NK, Lo SK. Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: implication in the pathogenesis of postoperative cholangitis. World J Surg 2001;25:1512–1518.

    Article  PubMed  CAS  Google Scholar 

  5. Tainaka T, Kaneko K, Seo T, Ono Y, Ogura Y, Wada H, et al. Hepatolithiasis after hepatic portoenterostomy for biliary atresia. J Pediatr Surg 2006;41:808–811.

    Article  PubMed  Google Scholar 

  6. Kawarasaki H, Itoh M, Mizuta K, Tanaka H, Makuuchi M. Further observations on cystic dilatation of the intrahepatic biliary system in biliary atresia after hepatic portoenterostomy: report on 10 cases. Tohuku J Exp Med 1997;181:175–183.

    Article  CAS  Google Scholar 

  7. Chuang JH, Lee SY, Shieh CS, Chen WJ, Chang NK. Reappraisal of the role of the bilioenteric conduit in the pathogenesis of postoperative cholangitis. Pediatr Surg Int 2000;16:29–34.

    Article  PubMed  CAS  Google Scholar 

  8. Yagi M, Iwafuchi M, Uchiyama M, Takano K. Electromyographic study of the mechanism of postoperative cholangitis in congenital biliary atresia intestinal motility after Rouxen-Y biliary reconstruction. Pediatr Surg Int 1990;5:433–436.

    Article  Google Scholar 

  9. Tagge DU, Tagge EP, Drongowski RA, Oldham KT, Coran AG. A long-term experience with biliary atresia. Reassessment of prognostic factors. Ann Surg 1991;214:590–598.

    Article  PubMed  CAS  Google Scholar 

  10. Shinohara T, Muraji T, Tsugawa C, Nishijima E, Satoh S, Takamizawa S. Efficacy of urinary sulfated bile acids for diagnosis of bacterial cholangitis in biliary atresia. Pediatr Surg Int 2005;21:701–704.

    Article  PubMed  Google Scholar 

  11. de Bie HM, Kneepkens CM, Vos A, van Nieuwkerk CM. Late cholangitis after kasai procedure detected with magnetic resonance cholangiopancreaticography: a case report. J Pediatr Gastroenterol Nutr 2002;35:363–365.

    Article  PubMed  Google Scholar 

  12. Masaki Nio, Nobuyuki S, Tomohiro I, Hideyuki S, Yutaka H, Ryoji O. Cholangitis as a late complication in long-term survivors after surgery for biliary atresia. J Pediatr Surg 2004;39:1797–1799.

    Article  Google Scholar 

  13. Ogasawara Y, Yamataka A, Tsukamoto K, Okada Y, Lane GJ, Kobayashi H, et al. The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia: a prospective study. J Pediatr Surg 2003;38:1826–1829.

    Article  PubMed  Google Scholar 

  14. Komuro H, Makino S, Momoya T, Uehara Y, Tahara K, Momoi M. Cholangitis associated with cystic dilatation of the intrahepatic bile ducts after antireflux valve construction in biliary atresia. Pediatr Surg Int 2001;17:108–110.

    Article  PubMed  CAS  Google Scholar 

  15. Muraji T, Tsugawa C, Nishijima E, Satoh S, Takamizawa S, Ise K, et al. Surgical management for intractable cholangitis in biliary atresia. J Pediatr Surg 2002;37:1713–1715.

    Article  PubMed  Google Scholar 

  16. Hashimoto T, Otobe Y, Shimizu Y, Suzuki T, Nakamura T, Hayashi S, et al. A modification of hepatic portoenterostomy (Kasai operation) for biliary atresia. J Am Coll Surg 1997;185:548–553.

    Article  PubMed  CAS  Google Scholar 

  17. Bu LN, Chen HL, Chang CJ, Ni YH, Hsu HY, Lai HS, et al. Prophylactic oral antibiotics in prevention of recurrent cholangitis after the Kasai portoenterostomy. J Pediatr Surg 2003;38:590–593.

    Article  PubMed  Google Scholar 

  18. Wong KK, Fan AH, Lan LC, Lin SC, Tam PK. Effective antibiotic regime for postoperative acute cholangitis in biliary atresia—an evolving scene. J Pediatr Surg 2004;39:1800–1802.

    Article  PubMed  Google Scholar 

  19. Karrer FM, Lilly JR. Corticosteroid therapy in biliary atresia. J Pediatr Surg 1985;20:693–695.

    Article  PubMed  CAS  Google Scholar 

  20. Kobayashi H, Yamataka A, Koga H, Okazaki T, Tamura T, Urao M, et al. Optimum prednisolone usage in patients with biliary atresia postportoenterostomy. J Pediatr Surg 2005;40:327–330.

    Article  PubMed  Google Scholar 

  21. Hsieh CS, Huang CC, Huang LT, Tsai YJ, Chou MH, Chuang JH. Glucocorticoid treatment down-regulates chemokine expression of bacterial cholangitis in cholestatic rats. J Pediatr Surg 2004;39:10–15.

    Article  PubMed  Google Scholar 

  22. Tatekawa Y, Muraji T, Tsugawa C. Glucocorticoid receptor alpha expression in the intrahepatic biliary epithelium and adjuvant steroid therapy in infants with biliary atresia. J Pediatr Surg 2005;40:1574–1580.

    Article  PubMed  Google Scholar 

  23. Escobar MA, Jay CL, Brooks RM, West KW, Rescorla FJ, Molleston JP, et al. Effect of corticosteroid therapy on outcomes in biliary atresia after Kasai portoenterostomy. J Pediatr Surg 2006;41:99–103.

    Article  PubMed  Google Scholar 

  24. Yamashiro Y, Ohtsuka Y, Shimizu T, Nittono H, Urao M, Miyano T, et al. Effects of ursodeoxycholic acid treatment on essential fatty acid deficiency in patients with biliary atresia. J Pediatr Surg 1994;29:425–428.

    Article  PubMed  CAS  Google Scholar 

  25. Cuffari C, Seidman E, DuBois J, Brochu P, Alvarez F. Acute intrahepatic portal vein thrombosis complicating cholangitis in biliary atresia. Eur J Pediatr 1997;156:186–189.

    Article  PubMed  CAS  Google Scholar 

  26. Tanaka K, Shirahase I, Uemoto S, Yamamoto E, kato H, Moriyasn F, et al. Changes in portal vein hemodynamics after hepatic portoenterostomy in biliary atresia. Pediatr Surg Int 1992;7:260–264.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai, 200032, China

    Yi Luo & Shan Zheng

Authors
  1. Yi Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shan Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shan Zheng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luo, Y., Zheng, S. Current concept about postoperative cholangitis in biliary atresia. World J Pediatr 4, 14–19 (2008). https://doi.org/10.1007/s12519-008-0003-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-008-0003-0

Key words

Search

Navigation