Abstract
Purpose and Methods : The choice of treatment for small intestinal bleeding (SIB) associated with portal hypertension after surgery for biliary atresia (BA) is still controversial. Nine patients with BA developing SIB were treated in our institution. To assess the management for SIB, we reviewed clinical courses, methods of treatment and outcomes. Results : The ages at bleeding were between 2 years and 14.9 years old (average, 9.2 years old). Two patients had jaundice and 2 other patients had thrombocytopenia due to hypersplenism at SIB. Two patients eventually died. One died of liver failure and the other died of a complication after liver transplantation. SIB was not the cause of death in either patient. Of 7 survivors, no treatment except blood transfusion was performed in 2 patients who recently developed SIB. SIB recurred in 2 patients who underwent dissection of collateral vessels. Partial splenic embolization (PSE), which was employed in 2 patients with hypersplenism, and ligation of collateral vessels in one were effective to control bleeding. Two patients developed pulmonary vascular abnormalities : hepatopulmonary syndrome and portopulmonary hypertension, respectively. Conclusion : Although the liver transplantation should be considered in progressive liver cirrhosis, patients with good liver function and controllable bleeding could be expected to have a favorable prognosis.
