Neonatal Congenital Biliary Atresia with Cirrhosis: Reversal After Kasai Procedure and Combined Chinese-Western Medicine — A Case Report with 7-Year Follow-up

Abstract Background: Congenital biliary atresia (CBA) is a progressive obstructive cholangiopathy that begins during mid-to-late embryonic development. Hepatic injury and cholestatic cirrhosis are already present at birth. Even after Kasai portoenterostomy, many patients develop progressive cirrhosis and eventually require liver transplantation. We report a case of cirrhosis reversal in a male neonate with CBA following combined Chinese-Western medicine treatment, with 77 consecutive 30-day treatment cycles (approximately 6 years and 4 months) and a 7-year follow-up. Case Presentation: A male infant was diagnosed with CBA at 25 days of age and underwent Kasai portoenterostomy. Intraoperative findings revealed a nodular liver surface, confirming cirrhosis that had already formed in utero. Postoperatively, liver stiffness progressively increased (9.1 kPa, then 14.2 kPa during an episode of respiratory infection and ibuprofen exposure), further confirming progressive cirrhosis. Combined Chinese-Western medicine was initiated on March 28, 2019. Serial FibroScan examinations showed a stepwise regression of liver stiffness to 6.9 kPa (2021), 4.4 kPa (February 2026, independent examination at another tertiary hospital), and 5.44 kPa (August 2026, Beijing Children's Hospital). Liver function tests normalized, with only mild residual elevations of ALT and GGT that are clinically insignificant. The child is now attending primary school with normal growth and development.