Biliary atresia associated with meconium peritonitis caused by perforationof small bowel atresia

Background/Purpose: This report describes our experiences with 5 cases of b iliary atresia associated with meconium peritonitis caused by perforation o f small bowel atresia. Methods: A review of medical records was undertaken in an effort to recogni ze cases of biliary atresia associated with meconium peritonitis. Results: Five patients of 171 with biliary atresia (2.9%) were detected to have meconium peritonitis caused by perforation of small bowel atresia. The biliary atresia was not suspected during the initial operation for meconiu m peritonitis. Total parenteral nutrition (TPN) made it difficult to make a n early differential diagnosis of biliary atresia because of the presence o f TPN-associated cholestatic jaundice, and the Rouexen-Y limb used for hepa tic portoenterostomy could not be made long enough to prevent cholangitis c aused by preexisting short bowel. The main complications were severe, intra ctable cholangitis, short bowel syndrome with malnutrition; TPN-associated liver injury; and wound problems. Two patients died of ascending cholangiti s, 1 patient of liver failure that was exacerbated by TPN-associated liver injury, and 1 patient is awaiting a liver transplant. Only 1 patient is in good health, being anicteric and showing normal growth and development. Conclusions: Biliary atresia is evidently closely associated with meconium peritonitis caused by perforation of small bowel atresia. The management of these patients is more difficult than that of patients with the usual form of biliary atresia, because of the necessity for a long period of TPN and the combined short bowel syndrome. The ideal management of these conditions has yet to be determined. J Pediatr Surg 36:1390-1393, Copyright (C) 2001 by W.B. Saunders Company.