Abstract
Anastomotic stricture and intrahepatic lithiasis are well-known long-term complications after surgery for congenital biliary dilatation (CBD). However, stenosis of the Roux-en-Y limb caused by a stapler stump is extremely rare. We report the case of an 8-year-old girl who developed cholangitis 4 years after undergoing laparoscopic extrahepatic bile duct resection and hepaticojejunostomy for CBD. Imaging revealed dilatation of the intrahepatic bile ducts with suspected anastomotic narrowing. Conservative treatment with antibiotics and biliary drainage temporarily improved her symptoms. Double-balloon enteroscopy was attempted but failed to reach the anastomosis. Elective laparotomy was performed. Intraoperatively, a stapler stump was found adherent to the jejunal mucosa, causing a localized luminal stricture. The redundant mucosa was excised, and concomitant hepaticojejunostomy stricture was treated with intraoperative balloon dilation using a biliary dilation catheter. Her postoperative course was uneventful, with no recurrence of cholangitis during follow-up. Stapler-stump-induced jejunal stenosis is uncommon but it is thought to be caused by excessive inversion during margin burial, and caution is required as it may cause postoperative cholangitis. When endoscopic management of biliary strictures is not feasible, reoperation combined with intraoperative balloon dilation may provide a safe and effective treatment option.
