Q. What are the complications after portoenterostomy?
A. Every patient of PE, irrespective of the success of the procedure is vulnerable for ascending infection from the anastomosed Roux-en-y intestinal loop and is likely to have one or more episodes of ascending cholangitis (AC). AC is diagnosed by the onset of fever and worsening of the liver biochemistry. Many surgical modifications have been suggested to prevent AC, but none of them are foolproof. We have tried keeping longer Roux-en-y loops, but that has not changed the incidence of AC in our patients. Whenever AC is diagnosed, the child is admitted and liver biochemical tests and a full septic workup is performed (including blood culture). Appropriate parental antibiotic therapy is instituted. If the patient shows no response in 48 hours, then steroids are given.

Ascites and portal hypertension are other problems, which are commonly encountered after portoenterostomy and need proper management.

Q. What is the nutritional support given to these patients?
A. In breastfed babies, breastfeeding is continued and supplemental medium chain triglycerides (MCT) based feeds are given. Older children are given a diet rich in calories (200Kcal/kg/day), rich in MCT, glucose polymers, proteins (1-2g/kg/day), vitamins, minerals and trace elements.

Vitamin A is supplemented in the dose of 50,000IU IM (at diagnosis or day 5 post operatively) and then 10,000 IU monthly till cholestasis diminishes.

Vitamin D is given in the dose of 30,000 IU IM (at diagnosis or day 5 post operatively) and then monthly till cholestasis diminishes. If the child has radiological evidence of rickets, give a dose of 60,000IU.

Oral Vitamin E and Vitamin K supplements are also required.

Also See "Frequently Asked Questions By Parents On Jaundice"

Last created on 23-02-2001
Last updated on 01-05-2007