Ascending cholangitis after successful surgical repair of biliary atresia

Abstract

Since the introduction of hepatic porto-enterostomy, encouraging results have been obtained in treating extrahepatic biliary atresia, particularly in the case of infants with atresia or agenesis of the extrahepatic ducts, who would not previously have been considered amenable to surgery.

Out of 17 successfully repaired cases who had shown good bile excretion after surgery and who had no jaundice, 8 (47%) developed ascending cholangitis 3½ to 8½ months after surgery.

Cholangitis of this type formed a recognizable picture, with repeated attacks of fever, reappearance of obstructive jaundice, raised erythrocyte sedimentation rate, leucocytosis with shift to the left, and anaemia. The condition was often resistant to antibiotic therapy, and was fatal in 3 cases.