Clinical analysis of delayed bile leakage with extrahepatic bile lake after Kasai operation in infants with biliary atresia
Objective To explore the diagnosis and treatment of delayed bile leakage with extrahepatic bile lake after Kasai operation in infants with biliary atresia(BA).Methods From January 2005 to April 2021,the relevant clinical data were retrospectively reviewed for 4 BA infants of delayed bile leakage with extrahepatic bile lake after Kasai operation.There were 2 boys and 2 girls.The median age at Kasai operation was 44(37-84)day.The levels of leucocytes,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transferase,total bilirubin and direct bilirubin were compared before and after the formation of extrahepatic bile lake.And clinical characteristics,diagnosis and treatment were summarized.Results Leucocytes,alanine aminotransferase,aspartate aminotransferase and γ-glutamyl transferase spiked at admission.Yet total bilirubin and direct bilirubin declined.All of them received antibiotics and underwent percutaneous transcystic drainage(PTD).PTD was ultrasound-guided(n=3)and one case underwent laparoscopic PTD due to biliary peritonitis.Drainage tube was removed after 4-5 weeks(n=2).All of them were cured.Neither bile leakage nor bile lake recurred during a follow-up period of 6 months.One case of laparoscopic PTD died at Month 10 after Kasai surgery due to cholangitis and liver failure.The remainders survived with native liver and were still under follow-ups.Conclusions Delayed bile leakage with extrahepatic bile lake after Kasai operation is rare in BA infants.It may be prevented by accurate operations.A definite diagnosis is based upon color Doppler ultrasound and other auxiliary examinations.PTD is both safe and effective for delayed biliary leakage after Kasai.
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