Biliary atresia : The example cases in surgical treatment

 We reported 2 example cases of biliary atresia. Both of them had clinical cholestasis jaundice in late neonatal period, and passed clinical evaluation process. We found that intraoperative cholangiography reveal pathology clearly before the definite surgery-hepatic portoenterostomy or Kasai’s operation-which performed at 58 days and 108 days of age respectively. The first case recovered completely within age of 7 months. And the second case had biliary cirrhosis. The pathology was too far for surgery to treat her disease.

Neonatal Cholestasis : Biliary Atresia, the Possible Solution

Bachground : Neonatal cholestasis is defined clinically abs the accumulation in the blood conjugated bilirubin higher than 2 mg/dl or a fraction greater than 20 % of an elevated total bilirubin level. The clinical features of any form of cholestasis are similar, including jaundice, dark yellow urine and pale stools. The correct diagnosis of biliary atresia and neonatal hepatitis is important because the clinical course of these two diseases are different. In biliary atresia if Kasai operation would not be performed within 2 months of age, the child will end up with biliary cirrhosis and die at average age of one and a haff year.Objective :\  To assess the problem of diagnosis and result of treatment in order to improve management guildline for neonatal cholestasis.Study design : Retrospective descriptive study. The medical records of patients with neonatal cholestasis during Jury 1997 to July 2000 were used in this study.Results : There 33 cases of patients, 20 males, 13 females with average age was 82.69  34.39 days. A Conbination of blood test for congenital infection, imaging by ultrasound, DISIDA scan, exploratory laparotomy with intraoperative cholangiography (IOC) and histological study aided in establishing the diagnosis and differentiating biliary atresis from other causes of neonatal cholestasis. There were 13 cases of biliary atresia, 5 cases were neonatal hepatitis and 15 cases were cholestasis with non specific causes. The mean age was 78.07,57.0,97.73 days in group of libiary atresia, neonatal hepatitis, and cholestasis group respectively, The most reliable investigation was exploratory laparotomy and IOC. Kasai operation was done in only 8 cases. Only 2 had good result and liver transplantation was required in one of these. The others had cirrhosis. There were 3 cases in the neonatal hepatitis group and 7 cases in cholestasis group had results.Conclusions : The early definite diagnosis of neonatal cholestasis is the most important especially biliary atresia which the early operative treatment is crucial. There for, the parents are given advise that jaundice with pale stools after age of 2 \– 3 weeks should be regarded as abnormal. The first wellbaby examination should be happens at 4 weeks of age. The appropriate investigations should be performed for detection of biliary atresia which surgical procedure can safe their lives.Key words : neonatal cholestasis, biliary atresia, neonatal hepatitis.

Iron Deficiency Anemia caused from Hemangioma of the Intestine.

Background:  Iron-deficiency anemia is the most common medical problem.  The  common causes of iron-deficiency anemia in  children are inadequate iron intake or the result of a parasitic infestation.  We report a case of hemangioma, which caused prolonged gastrointestinal bleeding and a subsequent iron-deficiency anemia.Objective:  To report the treatment of iron-deficiency anemia caused by a hemangioma at the jejunoileal junction.Results:  A seven-month-old male was admitted with anemia.  A physical examination revealed marked paleness but no hepatosplenomegaly.  Laboratory evaluations indicated an iron-deficiency anemia and positive stool blood occult.  The infant was treated for a cow’s milk allergy by changing to isomil, for iron deficiency anemia by iron supplyment.  The iron-deficiency  anemia remained unresolved after 4 months.  Then a Pertechnetate scintigraphy showed an abnormal increased uptake at left lower abdomen suggesting the lesion had a gastric mucosa component.  Surgery revealed a worm-like vascular structure with contact bleeding at the serosal surface of the jejunoileal junction.  A segmental small bowel resection, with end-to-end anastomosis, and appendectomy were performed.  A pathological examination confirmed hemangioma, so the child was given iron supplements.  His condition was stable at the six-month follow-up. Conclusion:  Hemangioma at the jejunoieal junction caused prolonged gastrointestinal bleeding and an iron-deficiency anemia.