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Obstruction of the Roux limb after portoenterostomy for biliary atresia: a delayed complication
J Levy1, E C Martin, A DeFelice
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
A Kasai portoenterostomy for extrahepatic biliary atresia was complicated by conduit obstruction. Percutaneous catheterization successfully resolved the obstruction, reestablishing bile flow and improving liver function.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Extrahepatic biliary atresia (EHBA) is a rare congenital condition requiring surgical intervention.
- Kasai portoenterostomy is a standard procedure for EHBA, aiming to restore bile drainage.
- Exteriorization of the portoenterostomy conduit is a less common surgical variation.
Observation:
- A 5-year-old girl with EHBA, status post Kasai portoenterostomy with an exteriorized conduit, presented with acute jaundice, acholic stools, and bacteremia.
- Symptoms were unresponsive to steroids and antibiotics, suggesting a mechanical obstruction.
- The clinical presentation pointed towards a complication at the exteriorized anastomosis site.
Findings:
- Percutaneous cannulation of the exteriorized portoenterostomy conduit was performed.
- Catheterization successfully identified and resolved an obstruction, likely a kinking of the conduit.
- Reestablishment of bile flow led to resolution of jaundice and stabilization of liver function.
Implications:
- This case highlights a potential complication of exteriorized portoenterostomy conduits in pediatric patients.
- Percutaneous intervention offers a minimally invasive approach to manage such obstructions.
- Successful management underscores the importance of timely diagnosis and intervention for conduit complications.
Abstract:
We report the case of a 5-year-old girl who underwent a Kasai portoenterostomy for extrahepatic biliary atresia. The conduit was exteriorized until 11 months of age. She was doing well, with stable portal hypertension until she suddenly developed jaundice, acholic stools, and bacteremia not responsive to a course of steroids and intravenous antibiotics. Suspecting obstruction at the site of the previously exteriorized anastomosis, a percutaneous cannulation of the conduit was performed. Catheterization of the conduit obstruction unkinked it and reestablished bile flow. She has remained anicteric with stable liver function.