Presentation on theme: "POST-OPERATIVE COMPLICATIONS OF BILIARY ATRESIA. HEPATOPORTOENTEROSTOMY -“Kasai procedure” - The most effective surgical treatment to promote bile flow."— Presentation transcript:
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.
ASCENDING CHOLANGITIS Increased jaundice Signs of sepsis Lighter stools Source: http://www.classkids.org/library/biliaryatresia.htm Intravenous and long- term oral antibiotics are used to prevent and treat ascending cholangitis. COMPLICATIONS AFTER KASAI PROCEDURE:
Source: http://www.classkids.org/library/biliaryatresia.htm http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm - 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. PORTAL HYPERTENSION In case of failed Kasai operation, portal hypertension is treated by liver transplantation, but often require sclerotherapy or variceal ligation before liver replacement. COMPLICATIONS AFTER KASAI PROCEDURE:
Source: http://www.md.ucl.ac.be/pedihepa/BILIARYATRESIA.htm - 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. INTRAHEPATIC BILIARY CAVITIES Cystoenterostomy or liver transplantation may eventually be required. COMPLICATIONS AFTER KASAI PROCEDURE:
Source: http://www.classkids.org/library/biliaryatresia.htm - 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. POOR GROWTH AND MALNUTRITION Special formulas containing medium- chain triglycerides (an easily digested form of dietary fat) and water-soluble vitamin supplements are often prescribed to maximize the child’s growth and development. COMPLICATIONS AFTER KASAI PROCEDURE: