WOFAPS 2025 8th World Congress of Pediatric Surgery

Kaushal Kulkarni, Pooja Prajapati, Vijai Datta Upadhyaya, Ankur Mandelia

SGPGIMS, Lucknow India

Background:
Choledochal cyst (CDC) excision followed by Roux-en-Y hepaticojejunostomy is the gold-standard treatment in children. While immediate postoperative outcomes are usually favorable, delayed mechanical complications such as Roux limb obstruction are extremely rare and often misdiagnosed due to vague symptomatology and unfamiliarity with this entity.

Objective:
To present a series of pediatric patients with Roux limb obstruction post-CDC excision, highlighting the clinical profile, diagnostic approach, surgical findings, and outcomes.

Methods:
We retrospectively reviewed four children (age range: 3–18 years; 2 males, 2 females) who presented between 3 weeks and 18 months after laparoscopic or robotic CDC excision with features of intermittent subacute intestinal obstruction. Data on symptoms, imaging, intraoperative findings, and interventions were collected.

Results:
A total of 100 patients with CDC were operated at our institute. All patients had recurrent abdominal pain, with non-bilious vomiting in three and cholestatic jaundice in one. Imaging (USG, CT, MRI) showed dilated bowel loops, pneumobilia, or transition points near the jejunojejunostomy. Diagnostic laparoscopy revealed diverse causes: internal herniation through mesenteric defects, kinking of the Roux limb at the jejunojejunostomy, and dense supracolic adhesions involving the Roux loop. Surgical interventions included adhesiolysis, mesenteric defect closure, and redo hepaticojejunostomy in one patient. All patients had complete symptomatic resolution postoperatively with no recurrence on follow-up.

Conclusion:
Roux limb obstruction is a rare but significant complication after CDC surgery. A high index of suspicion, thorough radiological evaluation, and timely laparoscopic re-exploration are crucial for optimal outcomes. Routine closure of mesenteric defects may prevent this complication.