Congenital Biliary Atresia A Histological Analysis of 40 Operated Cases

Abstract

Based on 40 cases of biliary atresia that were operated for portoenterostomy histopathological analysis was carried out with special reference on liver changes. Seven cases of neonatal hepatitis and 6 cases of choledochal cyst were included in the materials to elucidate the differentiating characteristics among them. The liver in biliary atresia showed a wide range of pathological features from minimal triaditis to advanced cirrhosis. To quantitate the degree of progressive widening of portal tracts, bile duct proliferation index was calculated to show a significant difference among cases of biliary atresia, neonatal hepatitis and choledochal cyst. Histopathological changes of extrahepatic biliary tree in biliary atresia were characterized by fibrosing inflammation with productive fibrosis involving entire biliary system. The findings were more pronounced in proximal portion than in distal portion, thus suggesting inflammation-fibrosis sequence in a proximal-to-distal direction. The patient age at the time of operation and the size of bile duct in proximal most portion of hepatic duct appeared the to be two most important factors in determining the long term survival after operation. Bile ducts larger than 200 f1 m in diameter seemd to be an important indicator for better prognosis. Hepatitis B seropositivity was present in 9 of 19 cases of biliary atresia that were examined. However, none of the livers that were stained with anti-HBsAg and anti-HBcAg was positive in immunohistochemical stains.