A Case of Cholangitis and Liver Damage as Cholestasis of Roux Loop After Surgery for Pancreaticobiliary Maljunction

Abstract

We report the case of a 16-year-old boy with trisomy 21. He underwent duodenojejunostomy for congenital duodenal atresia (apple-peel type) with annular pancreas at 12 days of age and hepaticojejunostomy for pancreaticobiliary maljunction at the age of 4 years. Frequent cholangitis and multiple intrahepatic bile duct stones occurred at the age of 14. Hepaticojejunostomy stenosis was suspected, and laparotomy was performed. Cholangiography revealed no hepaticojejunostomy stenosis. Hepaticojejunostomy was re-anastomosed for a wider anastomosis after intrahepatic cholangiolithotomy. At the age of 16, frequent cholangitis and liver damage occurred. Although CT and MRI revealed no cause of cholangitis, hepatobiliary scintigraphy revealed cholestasis in the loop of the jejunum; thus, dysfunction of the Roux loop was diagnosed. We performed partial resection of the loop and Roux-en-Y duodenojejunostomy for bile excretion. The clinical course of his illness was satisfactory after the operation. Evaluation of the function of the Roux loop is necessary to prevent cholangitis in the long-term follow-up.