Traumatic Avulsion of the Jejunojejunostomy After Kasai Portoenterostomy in a Child With Biliary Atresia: A Case Report

Introduction Biliary atresia is a rare pediatric hepatobiliary disorder treated with Kasai portoenterostomy early in life. Although pediatric surgeons are familiar with the altered anatomy associated with Kasai reconstruction, blunt abdominal trauma in these patients is rarely described. Case Presentation We present a 9-year-old female with biliary atresia following Kasai portoenterostomy who sustained blunt abdominal trauma during a motor vehicle collision. Preoperative imaging was notable for a positive FAST (Focused Assessment with Sonography in Trauma) in the pelvis. Emergent exploratory laparotomy revealed massive hemoperitoneum secondary to complete traumatic avulsion of the jejunojejunostomy associated with the prior portoenterostomy reconstruction, along with multiple bucket-handle mesenteric injuries. The hepaticojejunostomy remained intact. The Roux limb coursed in a retrocolic fashion with fixation at both the porta hepatis and retrocolic mesentery. Postoperatively, the patient remained sedated, paralyzed, and mechanically ventilated in the intensive care unit with an open abdomen. The patient required a staged reconstruction with drainage of the hepatobiliary limb during the index operation. Forty-eight hours later, she underwent jejunojejunostomy revision with restoration of enteric continuity and hepatobiliary drainage, followed by abdominal closure. She recovered well postoperatively and was discharged to rehabilitation for unrelated neurologic injuries sustained during the collision. Conclusion The double fixation of a retrocolic Roux-en-Y, such as the one used for a portoenterostomy, may predispose the jejuno-jejunal anastomosis to avulsion during rapid deceleration trauma.