WOFAPS 2025 8th World Congress of Pediatric Surgery

Pooja Prajapati, Vijai Datta Upadhyaya, Rahul Goel

sanjay gandhi post graduate institute of medical sciences, lucknow, india

Introduction: Early gastrointestinal (GI) bleeding (<30 days) following Kasai portoenterostomy (KPE) is an uncommon but potentially life-threatening complication in infants with biliary atresia (BA), contributing significantly to postoperative morbidity and mortality. The reported incidence ranges from 3.1% to 5.4%, with etiologies including coagulopathy, mucosal erosions, sepsis-related enteropathy, and rare vascular events such as right hepatic artery pseudoaneurysm (RHAPA).

Aim: To evaluate the etiological spectrum, management strategies, and clinical outcomes of early GI bleeding in infants with BA undergoing KPE, with a focus on rare vascular complications such as RHAPA.

Materials and Methods: A retrospective review was conducted of 194 infants with BA who underwent KPE between January 2016 and May 2025. Infants developing GI bleeding within 30 days postoperatively were included. Data on demographics, laboratory parameters, imaging, intraoperative findings, and clinical course were analysed. Initial evaluation included coagulation and sepsis screening, followed by Doppler ultrasound and CT angiography. Upper GI endoscopy (UGIE) was performed post-stabilization to exclude variceal sources.

Results: Six infants (M:F = 1:1) developed early GI bleeding, presenting with hematemesis (2), melena (3), or hemoperitoneum (1), at a mean of 9.5 days post-KPE (range: 3–20 days). RHAPA was diagnosed in two cases (33.3%) and managed successfully with coil embolization. One patient (16.6%) had stress gastritis, which resolved with PPIs infusion. Another (16.6%) had sepsis-induced coagulopathy, presenting with hemoperitoneum and GI bleeding. In two patients (33.3%), no identifiable cause was found; as one resolved spontaneously and imaging revealed no abnormality, and the other expired before evaluation. At a mean follow-up of 28 months, three patients are alive with jaundice clearance—two with native livers and one post-transplant.

Conclusion: Although rare, early GI bleeding following KPE requires high clinical suspicion. Prompt assessment of coagulation status and imaging is crucial for early diagnosis and intervention. RHAPA, though infrequent, must be considered in cases of massive bleeding to enable timely embolization and improve outcomes