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Intestinal obstruction after surgery for congenital biliary dilatation in children: diagnosis and management

Zhen-Sheng Liu1, Jian Bian1, Yong Yang1

  • 1Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, Anhui Province, China.

Frontiers in Pediatrics
|April 9, 2025
PubMed

Insights

Internal hernias are the main cause of intestinal obstruction after congenital biliary dilatation surgery in children. Early surgical intervention is recommended to prevent complications like Roux limb necrosis.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Complications

Background:

  • Congenital biliary dilatation (CBD) requires surgical intervention, often involving bile duct excision and Roux-en-Y hepaticojejunostomy.
  • Postoperative intestinal obstruction is a potential complication following these complex pediatric surgeries.

Purpose of the Study:

  • To investigate the causes and management strategies for intestinal obstruction after surgical treatment of congenital biliary dilatation in children.
  • To identify the primary etiologies contributing to postoperative intestinal obstruction in this specific patient cohort.

Main Methods:

  • A retrospective review of 475 pediatric patients who underwent Roux-en-Y hepaticojejunostomy for CBD.
  • Analysis of perioperative data for nine patients who required reoperation for intestinal obstruction.

Main Results:

  • Internal hernias (Petersen's, transverse mesocolic, Brolin's) were the predominant cause of obstruction (6/9 patients).
  • Other causes included biliary-jejunal loop torsion (1) and adhesions (2).
  • Cross-sectional imaging effectively identified internal hernias and Roux-en-Y volvulus, showing distended biliary-jejunal loops.

Conclusions:

  • Internal hernias are the leading cause of intestinal obstruction post-CBD surgery in children.
  • High diagnostic sensitivity of cross-sectional imaging aids in prompt diagnosis.
  • Early surgical intervention is crucial due to the risk of rapid progression to Roux limb necrosis.
Abstract

Keywords:
childrencholedochal cystcongenital biliary dilatationinternal herniaintestinal obstruction

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