Biliary Tract Disease in Pediatric Surgery Department: 10 Years Experience in Khouzestan-IRAN

Shahnam Askarpour, Hazhir Javaherizadeh, Fahime Abaforoush



Introduction and aim: The aim of this study was to evaluate clinical manifestation, and outcome of biliary tract disease in patients that referred for treatment in two referral centers of pediatric surgery of Ahvaz.

Patients and methods: This retrospective study was done in Imam Khomeini and Abuzar hospitals, two referral centers for pediatric surgery in Ahvaz.  Duration of study was 10 years starting from 1st March 2000. Patients who admitted due to biliary tract disease were included in this study. Age, sex, clinical manifestation, type of surgery, imaging finding, laboratory finding, duration of hospital staying, blood product infusion, and mortality  rate were recorded. Data were entered to SPSS Ver 13.0( Chicago, IL,USA). Chi-square and t-test were used for comparison.

Results: Twenty cases (m=13, f=7) of biliary atresia were included in this study. Mean of age at time of diagnosis and operation was 82.11 days (30 days- 6.5 months).  Jaundice (100%), acholic stool (55%), and dark  brown urine(55%) were the most frequent clinical manifestation in patients with biliary atresia. Of all cases, 17 patients underwent surgery. Eighteen cases (m=11, f=7) of cholecystitis were included in this study.  Abdominal pain (72%) is the most frequent sign.  Eleven cases underwent surgery. Five cases of choledochal cyst (m=0, f=5) were included in this study. Abdominal pain and vomiting is the most common clinical manifestation in cases with choledocal cyst.

Conclusion: Jaundice, acholic stool, and dark brown urine were the most frequent clinical manifestation in cases with biliary atresia. Mean age at the time of diagnosis and operation for BA cases was 82.11 days (30 days- 6.5 months). Abdominal pain was the most frequent sign of cholecystitis. Early referral and increasing experiences are  recommended to increase survival for BA cases in our hospital.


Full Text:




- Goldmann M, Panikoff T. Biliary disease in children. Curr Gastroenterol Rep 2011;13:193-201.

- Chardot C, Carton M, Spire-Bendelac N et al. Prognosis of biliary atresia in the era of liver transplantation: French national study from 1986 to 1996. Hepatology 1999; 30: 606-611.

- Davenport M, Ville de Goyet J, Stringer MD et al. Seamless management of biliary atresia. England & Wales 1999-2002. Lancet 2004;363:1354-1357.

- Hung PY, Chen CC, Chen WJ et al. Long-term prognosis of patient with biliary atresia: a 25 year summary. J Pediatr Gastroenterol Nutr 2006;42:190-195.

-Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 2009;52:434– 440.

- Tiao MM, Chuang JH, Huang L. . Management of biliary atresia: experience in a single institute. J Pediatr Surg 2004;67:250-277.

- Sasson SD, Yerushalmi B, Mordechay Y et al. Long term results of Kasai portoenterostomy for the management of biliary atresia. Harefuah 2009;148:161-211.

- Liem NT, Son TN, Quynh Ta et al:. Early outcomes of laparoscopic surgery for biliary atresia. J Pediatr Surg 2010;45:1665-7.

- Toyosaka SR, Okamoto E, Okasora T: Outcome of 21 patients with biliary atresia living more than 10 years. J Pediatr Surg 1993;28:1498-501.

- Elsadat AM: Biliary atreisa. experience with 30 consecutive cases in a single institute. Ann Pediatr Surg 2009;5:233-240.

- Al-Alawi A, Crankson SJ, Abdullah A. Extrahepatic biliary atresia in Saudi Arabia: the importance of early diagnosis and referral. Trop Gastroenterol 2001;22:2-20.

- Raval MV, Dzaakonic A, Bentrem DJ: Trends in age for hepatoportoenterostomy in the United States. Surgery 2010;148:785-91.

- Wildhaber BE, Majno P, Maye J: Biliary atresia: Swiss National Study,1994-2004. J Pediatr Gastroenterol Nutr 2008;46:299-307.

- Kieling CO, Santos JL, Vieira SM: Biliary atresia: we still operate too late. J Pediatr 2008;84:436-41.

- Schreiber RA, Barker CC, Roberts EA et al: Biliary atresia: The Canadian experience. J Pediatr 2007;151:659-65.

- Schoen BT, Lee H, Sullivan K et al: The Kasai portoenterostomy: when is it too late? J Pediatr Surg 2001;36(1):97-9.

- Serinet M-O, Wildhaber BE, Broué P et al: Impact of age at Kasai operation on its results in late childhood and adolescence: A rational basis for biliary atresia screening. Pediatrics 2009;123:1280–1286

- Liberek A, Gora-Gebka M, Boko W: Congenital extrahepatic biliary atresia as a course of cholestasis in newborns and infants. Med Wieku Rozwoj 2006;10:395-406.

- Oh M, Hobeldin M, Chen T et al: The kasai procedure in the treatment of biliary atresia. J Pediatr Surg 1995;30:1077-80.

- Matsui A, Ishikawa T: Identification of infants with biliary atresia in Japan. Lancet. 1994;343:925.

-Chang M: Screening for biliary atresia. Chang Gung Med J. 2006;29:231–233.

-Haber BA, Erlichman J, Loomes KM: Recent advances in biliary atresia: prospects for novel therapies. Expert Opin Investig Drugs 2008;17:1911 –1924.

-Ashcraft KW, Holcomb GW, Murphy JP: Pediatric Surgery. Edited by Holcomb GW. 4th ed. Saunders; 2004.

-Humphrey TM, Stringer MD. Biliary atresia: US Diagnosis. Radiology 2007;244:845-51.

- Singhavejsakul J, Ukarapol N: Choledochal cyst in children: epidemiology and outcomes. World J Surg 2008;32:1385-8.

- Huang CS, Huang CC, Chen DF. Choledochal cyst: differences between pediatric and adult patients. J Gastrointest Surg 2010;14:1105-10.

- Poddar U, Thapa BR: Choledochal cyst in infant and children. Indian Pediatr 1998;35:613-8.

- Watantittan S, Niramis R. Choledochal cyst: review of 74 pediatric cases. J Med Assoc Thi 1998:81(8):586-95.

- Elhalaby E, Hashish A, Elbarbary M et al: Roux -En-Y Hepaticojejunostomy versus Hepaticodudenostmy for Biliary Reconstruction after Excision of Choledochal Cysts in Children. Ann Pediatr Surg 2005;1:79-85.

-Savić Dj, Milovanović D, Jovanović D: [Congenital dilatation of the common bile duct (congenital choledochal cyst)]. Srp Arh Celok Lek 2001;129 Suppl 1:47-50. [Article in Serbian]



  • There are currently no refbacks.