title: Multiple orifices and cholangiography with a "fire-like" appearance after Kasai hepatoportoenterostomy for biliary atresia.
abstract: A 21-year-old female underwent a Kasai hepatoportoenterostomy with Roux-en-Y reconstruction for typeIII biliary atresia at age 63 days. At the age of 19 years, she developed cholangitis and CT scan revealed hepatolithiasis. She presented for treatment of the intrahepatic stone and the hepatportoenterostomy was directly visualized with double-balloon endoscopy (DBE). Endoscopic findings showed multiple intrahepatic bile ducts open to the jejunum through multiple orifices. Cholangiography showed narrowing of intrahepatic bile duct branches with a "fire-like" appearance. These findings have not been previously reported, since endoscopic approaches to patients with a hepaticojejunostomy were limited. DBE was useful to directly visualize the anastomosis in a patient status-post the Kasai operation for biliary atresia with a Rouxen-Y reconstruction.
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Kensuke
authors: K
authors: Yokoyama
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University. Electronic address: yokoporon0508_0513@yahoo.co.jp.
authors: Hisashi
authors: H
authors: Hatanaka
authors: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine.
authors: Mikihiro
authors: M
authors: Inoue
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Tomonori
authors: T
authors: Yano
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Norikatsu
authors: N
authors: Numao
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Jun
authors: J
authors: Ushio
authors: Department of Surgery, Jichi Medical University.
authors: Alan Kawarai
authors: AK
authors: Lefor
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Kiichi
authors: K
authors: Tamada
authors: Department of Medicine, Division of Gastroenterology, Jichi Medical University.
authors: Hironori
authors: H
authors: Yamamoto
mesh_terms: D001653:Bile Ducts, Intrahepatic / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001656:Biliary Atresia / Q000601:surgery*; D002758:Cholangiography; D002761:Cholangitis / Q000000981:diagnostic imaging* / Q000209:etiology; D058582:Double-Balloon Enteroscopy; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Biliary atresia; Cholangiography; Double-balloon endoscopy; Kasai hepatoportoenterostomy