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Title: | Internal biliary diversion to avoid liver transplantation in an adult with intractable pruritus due to idiopathic intrahepatic cholestasis |
Authors: | Siriwardana, R.C. Jayatunge, D.S.P. Ekanayake, C.S. Tilakaratne, S. Niriella, M.A. Gunetilleke, B. Dassanayake, A.S. |
Keywords: | Cholestasis, Intrahepatic Cholestasis, Intrahepatic-complications Pruritus Liver transplantation |
Issue Date: | 2020 |
Publisher: | Springer Nature |
Citation: | Egyptian Liver Journal. 2020; 10(1): 46 |
Abstract: | BACKGROUND: Cholestasis is due to the obstruction at any level of the excretory pathway of bile. One particularly troublesome symptom of cholestasis is pruritus which leads to a profound effect on a patient’s quality of life. In children with progressive familial intrahepatic cholestasis (PFIC), medical treatment often fails. An alternative surgical procedure using biliary diversion offers significant relief for intractable pruritus in non-responders. CASE PRESENTATION: A 43-year-old male presented with a history of persistent jaundice and intractable pruritus for a 2-month duration. His liver enzymes were markedly elevated. However, his liver synthetic function was preserved. After extensive evaluation, a cause for cholestasis was not identified. A multi-disciplinary decision was to consider liver transplantation, but as his liver synthetic functions were remarkably preserved and the intractable pruritus was the sole indication for a transplantation, it was finally decided that internal biliary diversion should be done for symptomatic relief. His pruritus dramatically improved at 6 weeks post-operative. His liver enzymes and bilirubin levels also decreased compared to his pre-operative status. Currently, his liver functions are being closely monitored. CONCLUSION: Though it is not used in adults, the experience of biliary diversion in children with PFIC shows that there is a considerable improvement of symptoms and postpone the need for a transplant. In our patient, liver function and bilirubin as expected did not show a major improvement. But the dramatic improvement of the symptoms gave us the time to postpone the liver transplantation. A biliary diversion is a reasonable option that needs to be considered even in adults with refectory pruritus due to cholestasis. |
Description: | Indexed in Scopus; Not Indexed in MEDLINE |
URI: | http://repository.kln.ac.lk/handle/123456789/21422 |
ISSN: | 2090-6218 (Electronic) 2090-6226 |
Appears in Collections: | Journal/Magazine Articles |
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File | Description | Size | Format | |
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Internal biliary diversion to avoid liver.pdf | 470.93 kB | Adobe PDF | View/Open |
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