A 4-week-old infant presents with progressive jaundice noted at 2 weeks of age, dark urine, and pale acholic stools. Liver function tests show conjugated hyperbilirubinemia with elevated gamma-GT. Ultrasound shows a non-visualized gallbladder and triangular cord sign. What is the most appropriate surgical management?

• A Cholecystojejunostomy
• B Pyloromyotomy
• C Hepatic transplant as first-line
• D Kasai portoenterostomy ✓

Explanation

Biliary atresia presents with progressive conjugated jaundice beyond 14 days, acholic stools, and dark urine. The triangular cord sign on ultrasound is characteristic. Kasai portoenterostomy is the primary surgical treatment and should ideally be performed before 60 days of age for best outcome. Choledochojejunostomy is not feasible as the extrahepatic ducts are obliterated. Hepatic transplant is reserved for failed Kasai or late presentations beyond 100 days.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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