Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series

Green, D. W.; Howard, E. R.; Davenport, Mark

doi:10.1111/j.1460-9592.2000.00579.x

Cited by 92 publications

(19 citation statements)

References 52 publications

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“…When the gallbladder is not visualized on prenatal US, differential diagnosis between gallbladder agenesis and congenital BA should be done [5][6][7][8]17] . Clinical management includes karyotyping, genetic testing for cystic fibrosis, and digestive enzyme analysis in amniotic fluid before 22 weeks [6,11,13,14,18] .…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis is crucial due to the poor prognosis of some of the entities. Gallbladder agenesis is a benign condition with an incidence of 1/6,300 [5,6] , while BA is a severe disease, associated with liver transplantation and death, that can benefit from early management [7][8][9][10] , raising the issue of pregnancy termination.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma

Ruiz¹,

Robles²,

Salva³

et al. 2017

Fetal Diagn Ther

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Introduction: Nonvisualization of the fetal gallbladder has been associated with benign conditions such as isolated gallbladder agenesis or severe diseases such as biliary atresia (BA). Recently, gamma-glutamyl transpeptidase (GGTP) fetal blood levels were reported as useful after 22 weeks. Objective: To determine the contribution of fetal blood GGTP levels after 22 weeks, based on 2 cases. Case 1: 20⁺⁴-week secundipara, with subcutaneous edema and pleural effusion. At 24⁺⁴ weeks, the gallbladder could not be visualized. Progressive hydrops deterioration was observed. 32⁺²-week magnetic resonance imaging (MRI) confirmed nonvisualization of the gallbladder. BA was suspected. The patient decided to terminate the pregnancy and fetal blood sample was obtained at feticide. GGTP was 573 IU/L. Fetal necropsy confirmed BA. Case 2: At the 22⁺⁶- and 24⁺⁰-week ultrasound scan, the gallbladder could not be visualized. Amniocentesis was offered, but declined by the patient. MRI at 35⁺⁰ weeks failed also to visualize it. Fetal cord blood sample at delivery was obtained, and GGTP was 129 IU/L. Ultrasound confirmed gallbladder agenesis with normal extra- and intrahepatic bile ducts. Conclusion: Cases of nonvisualized gallbladder after 22 weeks have rarely been reported in the literature. Until now, no standard management has been proposed. Our cases support the potential usefulness of fetal blood digestive enzymes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma

Ruiz¹,

Robles²,

Salva³

et al. 2017

Fetal Diagn Ther

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“…At the end of surgery, the tracheas of most neonates can be extubated. These neonates are best managed in a high-dependency unit with morphine analgesia [ 236 ].…”

Section: Anesthetic Considerations [ 230 ]mentioning

confidence: 99%

Thoracoabdominal and General Surgery

Cross

Smith

Walker

2014

Neonatal Anesthesia

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“…If left untreated it leads to worsening cholestasis, hepatic fibrosis, cirrhosis, portal hypertension and liver failure. [12]…”

Section: Biliary Atresiamentioning

confidence: 99%

Anaesthesia for biliary atresia and hepatectomy in paediatrics

Jacob

2012

Indian J Anaesth

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The scope of this article precludes an ‘in depth’ description of all liver problems and I will limit this review to anaesthesia for biliary atresia — a common hepatic problem in the very young — and partial hepatectomy in older children. I will not be discussing the problems of anaesthetising children with hepatitis, cirrhosis, congenital storage diseases or liver failure. Extrahepatic biliary obstruction is an obliterative cholangiopathy of infancy which is fatal if untreated. Diagnosis involves exclusion of other causes of neonatal jaundice and treatment involves a hepatico portoenterostomy carried out at the earliest. This is a review of current concepts in anaesthesia and postoperative management of neonates with extrahepatic biliary atresia. Anaesthesia for hepatic resection has seen great changes in recent times with the improvement in surgical techniques, technology and a better understanding of the underlying physiology. These are reviewed along with the problems of postoperative pain management.

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Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series

Cited by 92 publications

References 52 publications

Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma

Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma

Thoracoabdominal and General Surgery

Anaesthesia for biliary atresia and hepatectomy in paediatrics

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