Gallstone Obstruction in Roux-en-Y Hepaticojejunostomy: An Unusual Challenge After Liver Transplant for Biliary Atresia

Gallstone obstruction of the hepaticojejunostomy following Kasai hepatoportoenterostomy for congenital biliary atresia is extremely uncommon. More common complications of the Kasai procedure include bile duct strictures, fibrosis, portal hypertension, and cholangitis, which is likely due to reduced lymphatic drainage, intestinal bacterial translocation, and poor biliary drainage. In this study, we present a rare case of a stone lodged in the hepaticojejunostomy of a patient with a history of pediatric Kasai and orthotropic liver transplant for biliary atresia, managed with enterotomy and stone extraction.