Summary
Endoscopic inspection of the porta hepatis was undertaken through external enterostomy
in nine postoperative patients with biliary atresia. The endoscopic appearance of
bile flow in the porta hepatis was classified into three types. 1) Ductal type (D-type),
which revealed good bile flow from distinct bile duct orifices (4 cases); 2) Oozing
type (O-type), which showed adequate bile flow, but no definite bile duct (3 cases);
and 3) Covered type (C-type), in which the porta hepatis was covered with bile “clots”
and fibrous tissue (2 cases). The clinical course of the D-type was excellent with
immediate disappearance of jaundice and relatively good liver function. In the case
of the O-type, jaundice disappeared in 2 but persisted in one. Two patients with C-type
died of hepatic failure or sepsis in the early postoperative period. In the D-type
intrahepatic bile ducts were well visualized by cholangiography; however, those of
the O-type were not so clear. Endoscopic inspection of the porta hepatis is very useful
for evaluation of the postoperative state of bilioenteric fistulae in patients with
biliary atresia.
Key words:
Biliary atresia - Porta hepatis - Hepatic porto-enterostomy - Bilioenteric fistula
- Endoscopy
