Abstract
We report a case of afferent loop obstruction after the excision of a congenital choledochal cyst. The patient, a 21-year-old female, underwent cyst excision, together with hepaticojejunostomy (Roux-en Y) and insertion of a stenting into the Roux-en Y loop, at 7 years of age. She had been free of any significant abdominal symptom for 14 years, where she developed a sudden onset of abdominal pain two days prior to admission. A liver function test was abnormal and an abdominal CT scan showed a localized dilated small bowel loop. She underwent a laparotomy and was diagnosed with an afferent loop obstruction of the Roux-en Y loop. The laparotomy revealed torsion of the Roux-en Y loop involving the jejunojejunostomy region. As the affected intestine was viable, no bowel resection was required. Afferent loop obstruction of the hepatico-jejunostomy is extremely rare. It is difficult to make an accurate diagnosis because of the unusual symptoms, signs of bowel obstruction and rapid progression of the disease. It is suggested that this type of bowel obstruction could occur as a possible complication in patients with Roux-en Y hepatico-jejunostomy.
