Double-balloon endoscopy下Roux-en Y挙上空腸造影を用いて閉塞解除術を施行した小児肝移植後肝管空腸吻合部完全閉塞の1例

摘要

The frequent occurrence of biliary complications after liver transplantation remains a continuing problem. However, complete obstruction of a hepaticojejunostomy is rare. At the present time, almost all such cases undergo surgical treatment. We herein describe the case of a 13-year-old boy who underwent post Kasai's operation for biliary atresia. Six months after undergoing a living donor liver transplantation, obstructive jaundice suddenly appeared and therefore, percutaneous transhepatic cholangiodrainage was immediately performed. The cause of obstructive jaundice was determined complete obstruction of the hepaticojejunostomy. Although we tried to perform interventional radiology using double-balloon endoscopy, we were unable to reach the anastmotic site because of severe adhesion. Thereafter, we performed Roux-en Y jejunography using double-balloon endoscopy and cholangioscopy. As a result, we were finally able to identify the direction of the anastmotic site and the distance of the obstruction. We were thus able to puncture the anastomotic site and thereby remove the obstruction. At 3 years after undergoing the above described interventional radiology, the patient is doing well and the percutaneous transhepatic cholangiodrainage tube has also been removed. Even though double-balloon endoscopy cannot reach the anastomotic site in cases of complete obstruction of hepaticojejunostomy, we were nonetheless able precisely to identify the anastomotic site using Roux-en Y jejunography and cholangioscopy, and thereafter were able to perform minimally invasive treatment to remove the obstruction.