WOFAPS 2025 8th World Congress of Pediatric Surgery

Kübra Öztürk Yüzdemir ¹, Emre Ünal ², Tutku Soyer ¹, Özlem Boybeyi ¹

¹ Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara
² Hacettepe University Medical Faculty Department of Radiology

Background:

Choledochal cysts (CCs) are rare congenital anomalies of the biliary tree that require surgical excision. Postoperative anastomotic strictures may occur, typically within the early postoperative period. Delayed-onset biliary-enteric strictures are rare in pediatric patients and present unique diagnostic and therapeutic challenges. Magnetic compression anastomosis (MCA) has emerged as a novel minimally invasive approach for restoring biliary continuity in selected cases.

Case Presentation:

A 9-year-old girl, who had undergone excision of a Todani type-I choledochal cyst with Roux-en-Y hepaticojejunostomy at age 3, presented six years later with intermittent epigastric pain and postprandial, non-bilious vomiting. On examination, there was no jaundice; laboratory tests revealed only mildly elevated GGT and minimal direct hyperbilirubinemia. MRCP and cholangiography demonstrated a high-grade stricture located in the right hepatic duct, near the hepaticojejunostomy, resulting in significant upstream biliary dilatation, especially within the right hepatic biliary tree. Given the location and complexity of the stricture, magnetic compression anastomosis was planned. Under general anesthesia and sterile conditions, with ultrasound and fluoroscopy guidance, right biliary drainage catheter was used for contrast injection and right duct visualization. The non-dilated left segment II duct was cannulated. Two magnets were introduced—one from the right and one from the left intrahepatic ducts—and aligned across the stricture zone. Magnetic coupling was achieved in the occluded right hepatic duct near the anastomotic site. The procedure was well tolerated, and follow-up imaging confirmed successful biliary recanalization. The magnets were retrieved uneventfully. The patient experienced complete symptom resolution and normalization of liver biochemistry at follow-up.

Conclusion:

This case highlights that delayed-onset biliary strictures may occur even after long asymptomatic intervals following choledochal cyst resection. It also illustrates the effectiveness of percutaneous, fluoroscopy-guided magnetic compression anastomosis in managing anatomically complex, non-anastomotic strictures in pediatric patients, offering a viable minimally invasive alternative to surgical revision.