2025 Volume 61 Issue 1 Pages 66-71
We experienced treating a case of cholangitis, localized in the lateral segment of the liver, in an adult survivor of a post-Kasai operation for biliary atresia (BA). The patient was a 24-year-old female who underwent Kasai surgery on her 59th day of birth. Her type of BA was II-b1-β. The reconstruction technique was the original Roux-en-Y method with end-to-end fashioned hepatic port-enteric anastomosis. The patient visited the hospital with a fever following a SARS-CoV-2 infection. Escherichia coli was detected in her venous blood culture, and her levels of serum biliary system enzymes (γ-glutamyl transferase and alkaline phosphatase) were significantly elevated, but her jaundice was moderate and levels of liver enzymes (alanine aminotransferase and aspartate aminotransferase) were only slightly elevated. Abdominal CT findings were inconclusive. T2-weighted abdominal MRI showed findings indicating that a strong inflammation extended to areas along the portal vein in the lateral and medial segments. These findings were not observed in the right lobe. After the inflammation subsided, MRI-cholangiography revealed a continuous-rosary-bead-like hyperintensity area in the left lobe, which seemed to represent branching bile ducts. This morphological finding appeared to be a predisposing cause for the localization of cholangitis in the lateral liver segment. The bile duct–enteric anastomosis of the Kasai operation was completed distal to the left and right bifurcations. Consequently, it could be assumed that this technique probably limited the extension of cholangitis to the entire liver.
