Successful Medical Treatment for Recurrent Intestinal Bleeding Induced by Portal Hypertension in Biliary Atresia

Abstract

This report describes successful medical treatment of recurrent intestinal bleeding secondary to portal hypertension. The patient had previously had a Kasai's operation for biliary atresia (IIIb1ν), with an uneventful postoperative course. At one year and ten months of age, she developed massive melena which recurred frequently at short intervals. Upper endoscopic examination and scintigraphy did not show any bleeding. CT portography demonstrated a dilated mesenteric vein around the Roux-en-Y anastomosis. Laparotomy was performed for the purpose of identifying bleeding site of the intestine and resecting any congested bowel. However bleeding sites were not found, and the congested segment of the jejunum was too long to resect. Therefore, jejunectomy was not attempted, and she was subsequently started on spironolactone and propranolol. Since then, over two years of follow-up, she has not had any recurrence of melena.
Intestinal bleeding due to portal hypertension is relatively rare, and the diagnosis and treatment of intestinal bleeding have not been established due to the variety of clinical features it presents. However, medical treatment can prevent intestinal bleeding over the long-term, as in our case. Medical therapy is effective against intestinal bleeding secondary to portal hypertension, and hence medical treatment may be recommended prior to surgical treatment.