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Bagus Setyoboedi
Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia; Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Late Diagnosis of Biliary Atresia in an Infant- A Call for Early Cholestasis Screening and Timely Referral Yovani Savitri; Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief
MEDICINUS Vol. 39 No. 1 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/jqc0w953

Abstract

Background: Biliary atresia (BA) is a progressive, fibroinflammatory cholangiopathy and the leading cause of pediatric liver transplantation. Early diagnosis and timely Kasai portoenterostomy (KPE), ideally within the first 45–60 days of life, are critical to preserving native liver function and delaying disease progression. However, in many settings, delayed recognition and referral remain major barriers. Case: A 3-month-and-22-day-old female infant presented with persistent jaundice, acholic stools, and hepatosplenomegaly. Despite the onset of symptoms as early as day 3 of life, referral to a tertiary center was significantly delayed. Laboratory tests showed elevated liver enzymes (aspartate aminotransferase/AST 142 U/l, alanine aminotransferase/ALT 109 U/l, gamma-glutamyl transferase/GGT 1554 U/l, alkaline phosphatase/ALP 572 U/l), total bilirubin 9.84 mg/d, and direct bilirubin 8.31 mg/dl. Two-phase abdominal ultrasonography showed findings consistent with BA, including absence of the gallbladder and a positive triangular cord sign. Liver biopsy showed advanced-stage fibrosis (F3–F4), confirming the diagnosis of BA. Conclusions: Due to the delayed diagnosis and the presence of advanced liver damage, the golden period for effective KPE was missed, making liver transplantation the only definitive treatment option. This case highlights the urgent need for improved screening and early referral systems toenhance outcomes in infants with BA.
Delayed Referral of a Neonate with Biliary Atresia Presenting as Jaundice: A Case Report Zubaity Ardhanariswari; Rendi Aji Prihaningtyas; Muji Retnaning Rini; Muhammad Faizi; Bagus Setyoboedi
MEDICINUS Vol. 39 No. 4 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/rmdf9491

Abstract

Delayed diagnosis of cholestasis in infant remains a significant health problem. Cholestatic jaundice is a pathological condition that requires immediate treatment, particularly in cases such as biliary atresia. Biliary atresia is a progressivefibroinflammatory process that causes fibrosis in biliary tract, resulting in liver cirrhosis if left untreated. This case report aims to describe the delayed referral of biliary atresia in an infant. Case: A 3-month-old girl presented to a tertiary hospitalwith a chief complaint of jaundice. Jaundice had been present since the second day of life and persisted despite sun exposure and breastfeeding. The mother also reported abdominal distension, yellow-brown urine resembling tea, and palestools. Physical examination revealed hepatosplenomegaly. Laboratory results showed elevated liver enzymes (aspartate aminotransferase [AST] 237.4 U/l, alanine transaminase [ALT] 139 U/l, gamma-glutamyl transferase [GGT] 864 U/l), and cholestasis (total bilirubin 13.90 mg/dl, direct bilirubin 9.80 mg/dl). A two-phase abdominal ultrasound showed a gallbladder with preprandial size approximately 0.87 x 0.93 x 1.76 cm (length x width x height), with no contractility. Liver histopathologyrevealed extrahepatic cholestasis with extensive fibrosis (F3). The patient was diagnosed with biliary atresia and liver fibrosis and was subsequently referred for liver transplantation. Delayed referral of biliary atresia case is associated withpoor prognosis. Increasing awareness and health education among primary health providers, community health workers, and parents are essential for early detection of cholestasis, which can reduce morbidity, mortality, as well as the need for liver transplantation.
Co-Authors Muhammad Faizi Muji Retnaning Rini Rendi Aji Prihaningtyas Rendi Aji Prihaningtyas Sjamsul Arief Yovani Savitri Zubaity Ardhanariswari