Obstruction of the Biliary Limb of the Roux Loop After Successful Kasai Portoenterostomy for Biliary Atresia: Report of Two Cases

Background:Stasis within the biliary limb of the Roux loop is rarely reported after successful Kasai portoenterostomy (KPE) for biliary atresia (BA). Case Reports:This retrospective report describes 2 children (cases 1 and 2, aged 47 and 42 months) who underwent KPE for type 3 BA at 33 and 54 days of life, respectively, with postoperative jaundice clearance at 3 months (total bilirubin levels of 15 and 6 mol/L, respectively).Both children experienced frequent episodes of cholangitis (5 episodes each within 3 months and 1 month post-KPE, respectively); they presented with fever and elevated liver enzymes.Hepatobiliary scintigraphy demonstrated prompt hepatic uptake and excretion, with extrahepatic stasis in the Roux loop.Laparotomy (at 4 and 19 months of age, respectively) confirmed dense adhesions and bowel dilatation in the biliary limb in case 1, and at the T-junction of the enteroenterostomy of the Roux loop in case 2. Adhesiolysis, resection of the dilated bowel, and restoration of bowel continuity resulted in improved liver function, with cholangitis resolution during 33 months of follow-up in case 1 and 3 episodes of cholangitis over 23 months in case 2. Conclusions:Evaluation of recurrent cholangitis after successful KPE for BA may reveal bile stasis in the Roux limb.However, further studies are required to clarify any association or causal relationship before general recommendations can be made regarding surgical exploration to relieve biliary stasis and reduce the risk of cholangitis.