PORTAL HYPERTENSIVE ENTEROPATHY IN BILIARY ATRESIA

This paper describes a rare case of biliary atresia (BA) in which mass ive postoperative bleeding developed due to portal hypertensive entero pathy. A 15-year-old boy had been doing well after Kasai's operation f or BA. At around the age of 6 years he developed recurrent episodes of esophageal variceal bleeding and underwent esophageal transection, sp lenectomy, sclerotherapy, and embolization of the left gastric vein. A t the age of 15 years he suddenly developed abdominal pain, hematemesi s, and massive tarry stools. His hemoglobin level was 6.3 g/dl. Endosc opy showed several small, polypoid lesions in the jejunum beyond Treit z' ligament. The source of the bleeding was one of these lesions locat ed in the proximal jejunojejunostomy of the Roux-en-Y loop. Because he had repeated episodes of melena, he underwent partial resection of th e jejunum under endoscopic guidance. He has since been free of gastroi ntestinal (GI) bleeding. From this experience, we conclude that the po lypoid lesions of an enteropathy may be a cause of massive GI bleeding in the postoperative portal hypertension of BA.