Successful treatment of recurrent cholangitis complicating liver transplantation by Roux-en-Y limb lengthening

A 40-year-old male developed sepsis due to cholangitis. Five years earlier he underwent liver transplantation with hepaticojejunostomy. Over the past 18 months, he had 6 episodes of cholangitis. Radiologic studies demonstrated no biliary obstruction. Surgical intervention to eliminate bile reflux and stasis by lengthening the Roux-en-Y limb from 30 to 90 cm was curative. He has had no further episodes of cholangitis or hospitalization in the past 2 years. This case is the first description to our knowledge of a simple technique to treat recurrent cholangitis in patients with normal biliary anatomy, but inadequate biliary drainage following liver transplantation.