A Case of Small Bowel Torsion After Biliary Atresia Operation with Intussusception Antireflux Valve

Abstract

The case was a 24-year-old female patient who had been operated on when she was 61 days old for biliary atresia via a Roux-en-Y procedure with an intussusception antireflux valve. She was admitted to our hospital with lower abdominal pain. Abdominal findings showed rebound tenderness, and abdominal CT suggested dilation of the small bowel at the left lateral abdomen. We diagnosed a strangulated ileus and performed an emergency operation. Intraoperatively, dilation and torsion of the small bowel were noted from the hepatocholangiojejunostomy to the limbs of Roux-en-Y. After release of the small bowel torsion, the tissue showing ischemic change was resected. An intussusception antireflux valve was found in the resected small bowel, and the lumen of the valve demonstrated significant stenosis. The intussusception antireflux valve has been advocated for the prevention of cholangiti, but in our present case it had inhibited the stream of bile and it seemed possible that this is what caused the small bowel torsion. Accompanied by an improvement in the prognosis of biliary atresia, late phase complications like portal hypertension and cholangitis have been a problem. We must always bear portal hypertension and cholangitis carefully in mind when interpreting abdominal findings. Author, I think this last sentence was a computer translation. Have I correctly guessed what you meant? Please check the original.