title: Post-portoenterostomy triangular cord sign prognostic value in biliary atresia: a prospective study.
abstract: The triangular cord sign (TC sign) is a sensitive and specific tool in prompt diagnosis of extrahepatic biliary atresia. The objective of this study is to evaluate post-operative TC sign presence in outcome prediction of infants with biliary atresia after Kasai hepato-portoenterostomy 27 infants and children with biliary atresia underwent 122 ultrasound examinations using both 5 MHz and 7 MHz convex linear transducers in 33 months follow up. For all infants TC sign identification was included pre-operatively, ultrasound was done 2 weeks post-operatively then bimonthly for 3 months, monthly for 2 months and every 3 months thereafter. 14 (53.8%) had post-operative TC sign. Once post-operatively positive, it remained positive throughout the study. It did not reappear in an initially post-operatively TC sign negative infant. Those having post-operative TC sign had statistically worse outcomes (0 became anicteric, 2 improved, 7 had progressive disease and 6 died) than those with a negative TC sign (p = 0.04) (3 became anicteric, 5 improved, 2 progressed and 1 died). Presence of TC sign post-operatively correlated with measure of removal of all fibrous cone at porta-hepatis during portoenterostomy (p = 0.026). Post-portoenterostomy TC sign is associated with more morbidity and mortality; and reflects inadequate surgical technique.
authors.affiliation: Department of Paediatrics, Cairo University, Egypt.
authors.forename: M A
authors.initials: MA
authors.lastname: Kotb
authors.forename: M
authors.initials: M
authors.lastname: Sheba
authors.forename: N
authors.initials: N
authors.lastname: El Koofy
authors.forename: S
authors.initials: S
authors.lastname: Mansour
authors.forename: H M
authors.initials: HM
authors.lastname: El Karaksy
authors.forename: N M
authors.initials: NM
authors.lastname: Dessouki
authors.forename: W
authors.initials: W
authors.lastname: Mostafa
authors.forename: M
authors.initials: M
authors.lastname: El Barbary
authors.forename: H E
authors.initials: HE
authors.lastname: El-Tantawy
authors.forename: S
authors.initials: S
authors.lastname: Kaddah
mesh_terms: D001656:Biliary Atresia / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011171:Portoenterostomy, Hepatic / Q000379:methods* / Q000401:mortality / Q000592:standards; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography