2021 Volume 57 Issue 1 Pages 27-32
A 55-day-old boy was referred to our hospital with a three-day history of white stool. Jaundice and triangular cord sign on sonography were recognized, and the patient was suspected as having biliary atresia. However, he showed remission of hyperbilirubinemia and acholic stool. The patient underwent an intraoperative cholangiography at the age of 84 days because hyperbilirubinemia recurred, and it demonstrated obstruction of the common hepatic duct. Histopathologic examination of liver biopsy specimens revealed biliary obliteration and portal fibrosis accompanied by ductular proliferation and neutrophil infiltration. However, re-remission of hyperbilirubinemia was recognized after surgery. Finally, the patient underwent the Kasai operation after reconfirmation of common hepatic duct obstruction on the second cholangiography at the age of 97 days owing to re-exacerbation of jaundice and acholic stool. The patient had a mild anemia with a hemoglobin concentration of 9.7 g/dl on first admission. His serum bilirubin levels had fluctuated in parallel with hemoglobin levels before surgery. It was thus speculated that anemia reduced bilirubin production, appearing as remission of jaundice, which caused a delay in the definitive diagnosis of biliary atresia in this patient. A comprehensive evaluation of anemia and stool color is important in planning cholangiography and radical operation in the treatment of biliary atresia.
