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Acute Liver Failure in Children
ABSTRACTS
n=5, needed re-exploration, vascular complications n=12, biliary n=12 and bowel n=10 complications. The major medical complications included infections and graft related complications like acute rejection/primary non-function/ delayed function 16 cases. The overall survival rate after liver transplantation in our group is 72% and the survival rate in the recent years is 85%. Conclusion: Our experience demonstrates the feasibility of liver transplantation in children with end stage liver disease in India with results comparable with those reported in the developed world.
OUTCOME OF RECONSTRUCTIVE HEPATICOJUJENOSTOMY FOR BILE DUCT INJURIES AFTER CHOLECYSTECTOMY Rachel Gomes, Nilesh Doctor Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
Liver Transplantation
Introduction: Major bile duct injury (BDI) after cholecystectomy that requires surgical repair, has associated morbidity affecting a patient’s outcome. The aim of this study was to analyze the perioperative and the long-term outcome after surgical repair of major BDIs at our institution and identify risk factors for the development of major complications. Methods: A retrospective study of 57 patients with major BDI after cholecystectomy referred to a tertiary hepatobiliary center from July 1999 to July 2011 and subsequently managed with reconstructive surgery was performed. Results: Of 57 patents 35 (61.4 %) were primary referred. Twenty-two (38.6%) were secondary referral, of which 17 were to correct reconstructive surgery performed elsewhere and 5 were after prior attempted endoscopic management. Seventeen (29.8 %) had local and systemic perioperative complications. Forty-seven percent developed an anastomotic stricture and 2 (3.5%) developed biliary cirrhosis on long term follow up. Thirteen (22.8%) had major complications bile leak, bleed, stricture and/or biliary cirrhosis. No association was found between age, type of cholecystectomy, type of injury, vascular injury and occurrence of major complications. Secondary referred patients after therapeutic interventions (P=0.30) and reconstructive surgery for intended final reconstructive repair performed elsewhere (P = 0.010) were associated with a significantly increased incidence of major complications. Secondary referral was also an independent predictor of major complications (p = 0.11). Conclusion: Primary reconstructive surgery for major BDIs after cholecystectomy at a tertiary hepato-biliary center is associated with a better outcome. Referral to a tertiary center after therapeutic interventions is an independent negative predictor of outcome.
S96
2ND INTERNATIONAL LIVER SYMPOSIUM–2014
ACUTE LIVER FAILURE IN CHILDREN A. V. Lalitha, Priyadarashini M. Kowtal, K. V. Vibin, D. Harshad Department of Pediatrics, PICU and Department of Gastroenterology, St. Johns Medical College Hospital, Bangalore, Karnataka, India Introduction: Acute liver failure (ALF) in children is uncommon but potentially fatal disease. The etiology of ALF varies in developing countries. Objectives: To study clinical profile of children with ALF in relation to demographics, etiology and outcome. Methods: A retrospective study collecting demographic, clinical, laboratory, and short-term outcome data of children (1 month to 18 years) diagnosed with ALF admitted in PICU between January 2003 and September 2012. Results: Eighty-five children were diagnosed with ALF. Mean age of presentation was 6 4.4 yrs with male: female: 1.2:1. 9 children were <1 year, 27 were between 1–5 year and 49 were >5 years.The major etiology of ALF included infections by hepatotropic viruses seen in 24.7% and sepsis induced liver dysfunction in 25.9%. Some of the ALF was secondary to dengue fever (9.4%), drug-induced hepatotoxicity (7.1%) and Wilson's disease (4.7%). The etiology could not be established in 24.7% (indeterminate). Jaundice was present in all the patients, 85% had features of hepatic encephalopathy, gastrointestinal bleeding was present in 56.4%, 60% required mechanical ventilation and 50% required inotropic support. The mortality rate was (48/85) 56.5%. Children with viral hepatitis showed good outcome (16/21) as compared with ALF due to other causes. PELD score among survivors was greater than non survivors (39 15 vs 29 13.7) with a significant P < 0.001.Children with grade 3[8/ 13(61%)] and grade 4[13/13(100%)] had the highest mortality. Majority of deaths were observed in children <1year (66.6%) followed by 57.1% in >5 year and 51.8% in 1-5year. Conclusions: In our study an equal percentage of children with ALF had viral hepatitis and sepsis as etiology. The etiology could not be established in quarter of cases. Grade 3 and 4 had worst outcomes. Infants experienced a higher mortality rate. This study will serve to identify factors that will help to predict the likelihood of death.
A STUDY OF PORTAL HYPERTENSIVE POLYPS Anand Vadivel, P. Ganesh Department of Digestive Health and Diseases, Government Peripheral Hospital, Kilpauk Medical College, Salem, Tamilnadu, India
© 2014, INASL
n=5, needed re-exploration, vascular complications n=12, biliary n=12 and bowel n=10 complications. The major medical complications included infections and graft related complications like acute rejection/primary non-function/ delayed function 16 cases. The overall survival rate after liver transplantation in our group is 72% and the survival rate in the recent years is 85%. Conclusion: Our experience demonstrates the feasibility of liver transplantation in children with end stage liver disease in India with results comparable with those reported in the developed world.
OUTCOME OF RECONSTRUCTIVE HEPATICOJUJENOSTOMY FOR BILE DUCT INJURIES AFTER CHOLECYSTECTOMY Rachel Gomes, Nilesh Doctor Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
Liver Transplantation
Introduction: Major bile duct injury (BDI) after cholecystectomy that requires surgical repair, has associated morbidity affecting a patient’s outcome. The aim of this study was to analyze the perioperative and the long-term outcome after surgical repair of major BDIs at our institution and identify risk factors for the development of major complications. Methods: A retrospective study of 57 patients with major BDI after cholecystectomy referred to a tertiary hepatobiliary center from July 1999 to July 2011 and subsequently managed with reconstructive surgery was performed. Results: Of 57 patents 35 (61.4 %) were primary referred. Twenty-two (38.6%) were secondary referral, of which 17 were to correct reconstructive surgery performed elsewhere and 5 were after prior attempted endoscopic management. Seventeen (29.8 %) had local and systemic perioperative complications. Forty-seven percent developed an anastomotic stricture and 2 (3.5%) developed biliary cirrhosis on long term follow up. Thirteen (22.8%) had major complications bile leak, bleed, stricture and/or biliary cirrhosis. No association was found between age, type of cholecystectomy, type of injury, vascular injury and occurrence of major complications. Secondary referred patients after therapeutic interventions (P=0.30) and reconstructive surgery for intended final reconstructive repair performed elsewhere (P = 0.010) were associated with a significantly increased incidence of major complications. Secondary referral was also an independent predictor of major complications (p = 0.11). Conclusion: Primary reconstructive surgery for major BDIs after cholecystectomy at a tertiary hepato-biliary center is associated with a better outcome. Referral to a tertiary center after therapeutic interventions is an independent negative predictor of outcome.
S96
2ND INTERNATIONAL LIVER SYMPOSIUM–2014
ACUTE LIVER FAILURE IN CHILDREN A. V. Lalitha, Priyadarashini M. Kowtal, K. V. Vibin, D. Harshad Department of Pediatrics, PICU and Department of Gastroenterology, St. Johns Medical College Hospital, Bangalore, Karnataka, India Introduction: Acute liver failure (ALF) in children is uncommon but potentially fatal disease. The etiology of ALF varies in developing countries. Objectives: To study clinical profile of children with ALF in relation to demographics, etiology and outcome. Methods: A retrospective study collecting demographic, clinical, laboratory, and short-term outcome data of children (1 month to 18 years) diagnosed with ALF admitted in PICU between January 2003 and September 2012. Results: Eighty-five children were diagnosed with ALF. Mean age of presentation was 6 4.4 yrs with male: female: 1.2:1. 9 children were <1 year, 27 were between 1–5 year and 49 were >5 years.The major etiology of ALF included infections by hepatotropic viruses seen in 24.7% and sepsis induced liver dysfunction in 25.9%. Some of the ALF was secondary to dengue fever (9.4%), drug-induced hepatotoxicity (7.1%) and Wilson's disease (4.7%). The etiology could not be established in 24.7% (indeterminate). Jaundice was present in all the patients, 85% had features of hepatic encephalopathy, gastrointestinal bleeding was present in 56.4%, 60% required mechanical ventilation and 50% required inotropic support. The mortality rate was (48/85) 56.5%. Children with viral hepatitis showed good outcome (16/21) as compared with ALF due to other causes. PELD score among survivors was greater than non survivors (39 15 vs 29 13.7) with a significant P < 0.001.Children with grade 3[8/ 13(61%)] and grade 4[13/13(100%)] had the highest mortality. Majority of deaths were observed in children <1year (66.6%) followed by 57.1% in >5 year and 51.8% in 1-5year. Conclusions: In our study an equal percentage of children with ALF had viral hepatitis and sepsis as etiology. The etiology could not be established in quarter of cases. Grade 3 and 4 had worst outcomes. Infants experienced a higher mortality rate. This study will serve to identify factors that will help to predict the likelihood of death.
A STUDY OF PORTAL HYPERTENSIVE POLYPS Anand Vadivel, P. Ganesh Department of Digestive Health and Diseases, Government Peripheral Hospital, Kilpauk Medical College, Salem, Tamilnadu, India
© 2014, INASL