Various investigations for viral hepatitis, autoimmune disease and Wilson’s disease were unhelpful. An abdominal ultrasound study and computed tomography (CT) scan showed dilatation of intrahepatic ducts and splenomegaly. Magnetic resonance cholangiopancreatography (MRCP) showed cystic dilatation of the hilar bile duct Selleckchem Peptide 17 and moderate dilatation of intrahepatic ducts. The gallbladder (GB) and common bile duct (BD) were clearly shown and the gallbladder appeared to be linked to intrahepatic ducts (Figure 1). Endoscopic retrograde cholangiopancreatography

(ERCP) was also performed and showed contrast passing from the common bile duct into the cystic duct and gallbladder (Figure 2). The common hepatic duct was not outlined. Endoscopy revealed esophageal and gastric

varices while CT angiography showed a normal hepatic artery, portal vein and inferior vena cava. At laparotomy, the patient had features of cirrhosis. An operative cholangiogram was performed by injection of contrast into the gallbladder and only showed contrast in the common bile duct, similar to findings at ERCP. In the process of mobilizing the gallbladder, bile ducts in the gallbladder bed were shown to communicate with the gallbladder. The common hepatic duct could not be identified but dissection revealed a hilar pouch containing bile. Two hepaticojejunostomies were performed to drain bile from the gallbladder BMS-354825 in vitro bed and from the hilar pouch. Splenectomy was also performed. The anastomoses in the gallbladder bed were shown to be patent by passage of contrast through a stent. Liver function tests returned to normal after Ponatinib order 8 months. This may be the first report of biliary atresia diagnosed in an adult. In this case, he had an unusual variant characterized by absence of the common hepatic duct (type II). The diagnosis was delayed because of the development of anastomoses between branches of the right hepatic duct and the gallbladder. Despite this,

there was persistent cholestasis with the development of biliary cirrhosis and portal hypertension. The surgical procedure appears to have been helpful in the short-term but the longer-term outcome remains unclear. Contributed by “
“We read with great interest the excellent article by Ghouri and coworkers,1 who reviewed the current literature on the levels of gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) as potential predictors of incident cardiovascular disease. The authors elegantly demonstrate that there may be a statistically significant association between higher GGT levels and incident cardiovascular disease events, although this association may be clinically questionable because it is confounded by age. In contrast, ALT levels are not significantly associated with cardiovascular risk.