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A modified laparoscopic esophagogastric dissociation for severe bile reflux in a neurologically impaired child
Stephen J Fenton1, Colleen M Fitzpatrick
1Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA. sfenton1@me.com
Insights
A neurologically impaired child developed severe bile reflux after gastrojejunostomy for gastroesophageal reflux disease. Laparoscopic revision to esophagogastric dissociation successfully managed the complication.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Case Report
Background:
- Gastroesophageal reflux disease (GERD) is common in neurologically impaired children.
- Roux-en-Y gastrojejunostomy is a surgical option for refractory GERD.
- Bile reflux can be a complication following gastric surgeries.
Observation:
- A case of a neurologically impaired child with a history of GERD is presented.
- The child developed severe symptomatic bile reflux post Roux-en-Y gastrojejunostomy.
- Symptoms included significant discomfort and feeding difficulties.
Findings:
- Diagnostic evaluation confirmed severe bile reflux as the cause of symptoms.
- Surgical management involved a laparoscopic revision.
- The revision procedure was a modified esophagogastric dissociation.
Implications:
- This case highlights the potential for severe bile reflux after gastrojejunostomy in pediatric patients.
- Laparoscopic revision to esophagogastric dissociation can be an effective treatment.
- Further research into optimal surgical strategies for complex GERD in neurologically impaired children is warranted.
Abstract:
The clinical scenario of a neurologically impaired child with a prolonged history of gastroesophageal reflux disease that underwent open Roux-en-Y gastrojejunostomy with subsequent development of severe symptomatic bile reflux is reported. The presentation, evaluation, and surgical management by laparoscopic revision to a modified esophagogastric dissociation are discussed.
