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Published on: February 10, 2023
Laparoscopic management of obstructive hepatoduodenal adhesions after open antireflux procedure
Amulya K Saxena1, Cornelia van Tuil
1Department of Pediatric Surgery, Medical University of Graz, Austria. amulya.saxena@meduni-graz.at
Insights
A rare complication of mechanical ileus occurred in a child after antireflux surgery due to duodenal adhesions. Laparoscopic surgery successfully resolved the obstruction and symptoms.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Severe gastroesophageal reflux in children often necessitates surgical intervention.
- Open antireflux surgery is a common approach for managing complex cases.
Observation:
- A 3-year-old child developed feeding abstinence and vomiting one month post-antireflux surgery.
- Initial investigations ruled out issues around the surgical wrap, but upper GI contrast revealed duodenal kinking.
Findings:
- Laparoscopic examination identified severe hepatoduodenal adhesions causing duodenal kinking and mechanical ileus.
- Adhesions were successfully dissected using laparoscopic techniques.
Implications:
- This case highlights a previously unreported complication of mechanical ileus secondary to hepatoduodenal adhesions after antireflux surgery.
- Laparoscopic management offers a minimally invasive solution for this specific post-surgical complication.
Abstract:
The case of a 3-year-old child who underwent open antireflux surgery for severe gastroesophageal reflux is presented. One month after the procedure, the child presented with abstinence from feeds, and vomiting after food intake. Esophagogastroscopy ruled out pathology in the area around the wrap. Upper gastrointestinal contrast studies demonstrated a kinking of the duodenal loop. Laparoscopy revealed severe adhesions between the duodenum and liver with kinking of the duodenum. The adhesions were taken down with careful dissection using hooked laparoscopic scissors. The symptoms subsided immediately after surgery and the further course and follow-up examinations were uneventful. The complication of mechanical ileus due to hepatoduodenal adhesions with severe kinking of the duodenum after antireflux surgery and with successful laparoscopic management has never been reported to date.