Periportal Fibrosis and contracted Gall bladder In USG of Hepatobiliary system- as a diagnostic factor and therapeutic strategy For Biliary Atresia

Abstract :

This study aims to establish the ultrasonographic finding of periportal fiosis and contracted gall bladder as diagnostic factor and therapeutic strategy for Biliary Atresia. Twenty five infants were taken into study from Jan 2014-March 2016.All the patients had undergone ultrasonography of whole abdomen. For assisting the diagnosis 20 children had HIDA scan and percutaneous liver biopsy. The diagnosis was supported by undergoing Kasai procedure in 18 children. It was further supported by histopathological report after Kasai procedure. The age of presentation varies from 45 days to 120 days. Most of the children had clinical presentation of Biliary Atresia ie persistent jaundice, alcoholic stool, and abdominal mass. For further diagnosis Ultrosongraphy of whole abdomen was done. USG finding in 19 patients revealed periportal fiosis ranging from 15 x09mm-20x12mm.In 17 patients the gall bladder was present which appeared to be irregularly contracted. In 4 patients saccular well defined gall bladder was present. In three patients gall bladder was absent. Among 20 patients with HIDA Scan and percutaneous liver biopsy 18 patients revealed features of Biliary Atresia. Among 18 patients who had undergone Kasai procedure, 16 patient revealed absences of Biliary tract and contracted gall bladder. Two patients had common bile duct and normal looking gall bladder. The tissue from the extrabiliary tract on histopathology after Kasai procedure also revealed periportal fiosis and chronic inflammatory cells. The findings in ultrasonography with periportal fiosis and contracted gall bladder aid in early diagnosis and therapeutic strategy of Biliary Atresia specially in Indian subcontinent where all the people cannot effort the expensive investigations. However larger study is required to establish this relation provided USG features are carefully analysed by an experienced operator.

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