Intrahepatic Biliary Tract Abnormalities in Children with Corrected Extrahepatic Biliary Atresia

Werlin, Steven L.; Sty, John R.; Starshak, Robert J.; Glicklich, Marvin; Nathan, Radha

doi:10.1097/00005176-198508000-00007

Cited by 30 publications

(31 citation statements)

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“…The following hypotheses of the mechanism of bile lake formation have been postulated so far: (1) Cyst formation is secondary to the extrahepatic as well as the intrahepatic duct fibro-obliterative process, leading to erosion and ulceration of the biliary epithelium, resulting in bile leakage [6]; (2) the ongoing inflammatory process results in intrahepatic biliary obstruction [16]; (3) ductal plate malformation is one of the factors [10]; however, these hypotheses remain have not been investigated histologically. We first investigated bile lakes by histological methods to elucidate the mechanism of bile lake formation.…”

Section: Discussionmentioning

confidence: 99%

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Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia

et al. 2007

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Bile lakes develop after hepatic portoenterostomy in some patients with biliary atresia, and have been regarded as an indication of poor prognosis. We reported that bile lakes have no epithelium of the bile duct on their wall, and are surrounded by bile ducts; however, the mechanism of bile lake formation is little known. We investigated histologically how bile ducts are formed using whole removed liver, and the characteristics of bile ducts around bile lakes. From April 1980 to July 2006, we encountered 84 patients with biliary atresia. Bile lakes were analyzed histologically in 11 patients who underwent liver transplantation in our hospital. Bile lakes had a fibrotic cyst wall and lacked epithelia. In most cases, bile stasis, calculi formation, damaged bile ducts, and invasion of inflammatory cells were observed around the bile lakes. Bile ducts around bile lakes were not stained by CD56, but bile ducts around liver lobuli were stained by CD56. The present study speculates that bile lakes would arise from original bile ducts, which are damaged, and fuse together after calculi are formed in bile ducts.

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Section: Discussionmentioning

confidence: 99%

“…Long-term follow-ups have elucidated that cystic lesions often develop after hepatic portoenterostomy [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. We have reported that cystic lesions should be classified into two pathologies: simple dilation of the bile ducts and bile lakes with no biliary epithelia [20].…”

Section: Introductionmentioning

confidence: 99%

Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia

et al. 2007

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“…It is thought, therefore, that the pathologic conditions described above remain in the liver of some postoperative BA patients, resulting in the progress of liver dysfunction. [16][17][18] We previously studied the anatomic structure of the liver in postoperative BA patients by using MRI examination and found that some patients had fibrous changes in a part of the liver or in the peripheral liver in the long term after portoenterostomy. 7 Yeung et al 8 reported on 2 postoperative BA patients who received liver transplantation, showing that the peripheral zone of the liver in these patients was fibrous with no ductules.…”

Section: Discussionmentioning

confidence: 99%

Evidence for segmental bile drainage by hepatic portoenterostomy for biliary atresia: cholangiographic, hepatic venographic, and histologic evaluation of the liver taken at liver transplantation

Takahashi

Masuda

Suzuki

et al. 2004

Journal of Pediatric Surgery

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“…[15][16][17] However, biliary duct dilatation did occur and had been postulated as being cystic malformation in patients with BA. 18 The true pathophysiology of choledochal cyst is still unclear and is thought to be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Lee

Yeung

Chang

et al. 2000

Journal of Ultrasound in Medicine

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We evaluated sonographically 162 children who met the criteria for biliary tract dilatation in the past 18 years. Of these, 131 patients were diagnosed as having anomalous dilatations of the biliary tree (including 112 with choledochal cysts and 19 with biliary duct dilatation and biliary atresia). Biliary tract dilatations in the other 31 patients were due to secondary causes or normal variants. All cases of intrahepatic biliary tree dilatation and those with both intra‐ and extrabiliary duct dilatations were anomalous. In 117 cases of extrahepatic biliary tract dilatation only, the mean diameter was widest in cases of choledochal cyst (21.4 +/‐ 12.1 mm, compared with cases of biliary tract dilatation with biliary atresia (10 +/‐ 2.4 mm), secondary biliary duct dilatation (8.5 +/‐ 1.5 mm), and normal variants (4.4 +/‐ 1.2 mm) (P < 0.001). Of the 43 infants with biliary tree dilatation, 24 (56%) had choledochal cysts and 19 (44%) had biliary tract dilatation associated with biliary atresia. Excluding cases associated with biliary atresia, the accuracy of diagnosing choledochal cysts in extrahepatic biliary tract dilatation was 71% and 97% using cutoffs of 7 mm and 10 mm as the minimum diameter, respectively.

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Intrahepatic Biliary Tract Abnormalities in Children with Corrected Extrahepatic Biliary Atresia

Cited by 30 publications

References 0 publications

Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia

Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia

Evidence for segmental bile drainage by hepatic portoenterostomy for biliary atresia: cholangiographic, hepatic venographic, and histologic evaluation of the liver taken at liver transplantation

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

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