J Korean Surg Soc.  2011 May;80(5):355-361. 10.4174/jkss.2011.80.5.355.

Home intravenous antibiotic treatment for intractable cholangitis in patients with biliary atresia following Kasai portoenterostomies

• Shin JH
• Chang EY
• Chang HK
• Kim SM
• Han SJ

• KMID: 2212161
• DOI: http://doi.org/10.4174/jkss.2011.80.5.355

Abstract

PURPOSE
Patients with biliary atresia (BA) treated with Kasai portoenterostomy may later develop intractable cholangitis (IC) that is unresponsive to routine conservative treatment. It may cause biliary cirrhosis and eventually hepatic failure with portal hypertension. Control of IC requires prolonged hospitalization for the administration of intravenous antibiotics. To reduce the hospitalization period, we designed a home intravenous antibiotic treatment (HIVA) which can be administered after initial inpatient treatment. In this study, we reviewed the effects of this treatment.
METHODS
We reviewed medical records of 10 patients treated with HIVA for IC after successful Kasai portoenterostomies performed for BA between July 1997 and June 2009.
RESULTS
The duration of HIVA ranged from 8 to 39 months (median, 13.5 months). The median length of hospital stay was 5.7 days per month for conventional treatments to manage IC before HIVA and, 1.5 days per month (P = 0.012) after HIVA. The median amount of medical expenses per month was reduced by about one tenth with HIVA. One patient underwent liver transplantation due to uncontrolled esophageal variceal bleeding, but the other nine patients had acceptable hepatic function with native livers.
CONCLUSION
HIVA may be an effective primary treatment for IC after Kasai portoenterostomies for BA, and reduce length of hospital stay and medical expense.

Keyword

Biliary atresia; Intractable cholangitis; Home intravenous antibiotics treatment

MeSH Terms

Anti-Bacterial Agents
Biliary Atresia
Cholangitis
Hemorrhage
Hospitalization
Humans
Hypertension, Portal
Inpatients
Length of Stay
Liver Cirrhosis, Biliary
Liver Failure
Liver Transplantation
Medical Records
Anti-Bacterial Agents

Figure

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  Fig. 1 The occurrence of intractable cholangitis (IC) and the application of home intravenous antibiotic treatment (HIVA) after Kasai portoenterostomies between July 1997 and June 2009.

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  Fig. 2 Progression and resolution of intractable cholangitis (IC) with home intravenous antibiotic treatment (HIVA): cholangitis events recurred in spite of several attempts to control IC before HIVA in the first 2 patients (patients 1 and 2). IC was eventually controlled by HIVA in all patients. PTBD, percutaneous transhepatic biliary drainage; Tx, treatment.

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  Fig. 3 (A) Intrahepatic biliary cysts (IHBCs) related to intractable cholangitis in patient 1 shown by magnetic resonance cholangiopancreatography. (B) Remaining IHBCs after hepatic cystojejunostomy in patient 1 shown by computed tomography.

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