Partial splenic embolization decreases the serum bilirubin level in patients with hypersplenism following the Kasai procedure for biliary atresia.

Abstract

Partial splenic embolization (PSE) has been used in the palliative treatment of adults and children with hypersplenism. However, there has been no previous report of its use in the treatment of patients with jaundice. The purpose of this study was to investigate the utility of PSE in the treatment of jaundice in patients with biliary atresia and hypersplenism. Partial splenic embolization was performed in eight patients with biliary atresia and hypersplenism that developed following the Kasai procedure. Seven of them had experienced complete resolution of jaundice postoperatively, but became icteric thereafter. Jaundice remained unchanged in the initial postoperative period in the last patient but subsequently worsened. White blood cell, platelet, and red blood cell counts, hematocrit, and hemoglobin concentrations, and serum concentrations of glutamic-oxaloacetic transaminase, glutamate pyruvate transaminase, alkaline phosphatase, lactate dehydrogenase, albumin, and total bilirubin were evaluated one month before PSE and one, two, three, six, nine, 12, 18, and 24 months after PSE. The total bilirubin concentration decreased in all patients after PSE from 8.6 +/-3.6 mg/dL to 3.0 +/-1.0 mg/dL. This change was noted within three months of PSE, and correlated with an increase in the red blood cell count. Partial splenic embolization is a useful method for reducing serum bilirubin concentrations in patients with hypersplenism following the Kasai procedure for biliary atresia.