Abstract
A 10-year-old girl underwent Kasai operation for biliary atresia at 5 months of age, and living donor liver transplantation with left lateral segment graft at 9 months of age. She was referred to our hospital because of a sudden onset of right side abdominal pain and vomiting. CT scan showed the whirl sign, and she was diagnosed with having small bowel volvulus. At the emergent laparotomy, the twisted small intestine, with 270° counter-clockwise rotation, was reduced and no ischemic bowel was found. It was revealed that the elevated ileo-cecal region and upper jejunum adhered to the point of the Roux-en-Y loop passing through the transverse mesocolon. This adhesion caused the narrowing of the mesentery, and the volvulus. Adhesiolysis around the Roux-en-Y loop was performed. Eight days after the operation, she underwent re-laparotomy because of the recurrence of the volvulus. After the reduction of the volvulus, terminal ileum and upper jejunum were fixed to the retroperitoneum. The patient recovered well after this procedure. It was thought that the cause of the elevation of the ileo-cecal region was unfixation of the ileo-cecal region in infancy. It is suggested that this type of volvulus could occur as a possible complication in the patient with Roux-en-Y hepaticojejunostomy at liver transplantation in infancy.
