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March 1960

Successful Treatment of Congenital Atresia of the Extrahepatic Bile Ducts: A Case Report of Treatment by Hepatotomy and Fistula Formation

Author Affiliations

From the Departments of Surgery and Pediatrics, Sinai Hospital of Baltimore, Inc., and The Johns Hopkins University School of Medicine. Present address of Dr. Levin: Department of Pediatrics, Kaplan Hospital, Rehovoth, Israel.

AMA Arch Surg. 1960;80(3):473-481. doi:10.1001/archsurg.1960.01290200117021

As infants born with congenital atresia of the extrahepatic biliary tract usually die within months to a few years after birth, any surgical approach which offers hope of a cure or alleviation of symptoms warrants thorough investigation. The remarkable course of one such infant who had been explored for jaundice at the age of 3 months is the reason for this report. At age 11 months he was found to have an intraperitoneal biliary cyst which had been tapped at regular intervals for relief of what was considered to be ascites. This relieved his jaundice and probably spared his liver from more extensive biliary cirrhosis. The cyst was marsupialized. At age 14 months a hepatotomy and Roux-en-Y hepatojejunostomy were performed. He developed an external biliary fistula which later communicated with the Y-limb of the jejunostomy and was later converted to an internal fistula merely by clamping the drainage tube. The