Hybrid interventional radiological and surgical approach to treat biliary obstruction post Kasai portoenterostomy: A case report

Kasai procedure is used in the management of biliary atresia. Complications can include structuring at anastomoses which can result in impeded bile flow and subsequently ascending cholangitis that requires management. We present a case of a 4-years old with multiple episodes of ascending cholangitis in the context of prior Kasai portoenterostomy at day 56 of life for non-syndromic biliary atresia. After prolonged hospital admission, imaging in the form of US and MR-cholangiopancreatography showed an obliterated portoenterostomy. A combined surgical and Interventional Radiology approach was utilized in the form of the surgical creation loop jejunostomy within the Roux limb and then traversing of the portoenterostomy under fluoroscopically to dilate the stricture and place an internal-external biliary drain. Subsequently, the patient’s hyperbilirubinemia resolved with no further episodes of ascending cholangitis in 3 years of follow-up. A hybrid, percutaneous and surgical approach is a feasible option to restore bile flow in patients post-Kasai who develop delayed cholestasis due to obliteration of the portoenterostomy