{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:30Z","timestamp":1753891950000,"version":"3.41.2"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyze etiologies and management of postoperative intestinal obstruction following surgery (exeision of the dilated bile duet and Roux-enY hepaticojejunostomy) for congenital biliary dilatation (CBD) in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single-institution retrospective review was conducted on 475 patients who underwent Roux-en-Y hepaticojejunostomy following complete excision of the dilated bile duct. Among the cohort, nine patients underwent reoperation for intestinal obstruction. The perioperative data of these cases were thoroughly analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort (8F:1M) developed obstruction 20 days-8.8 years postoperatively. Primary etiologies included internal hernias (Petersen's:2, transverse mesocolic:3, Brolin's:1), biliary-jejunal loop torsion (1), and adhesions (2). Three patients underwent redo biliary-enteric anastomosis secondary to Roux-en-Y loop necrosis. Cross-sectional imaging in children with internal hernia or Roux-en-Y volvulus demonstrated distended, fluid-filled biliary-jejunal loops at the porta hepatis. Surgical indications for intestinal obstruction included peritoneal signs, aggravated abdominal pain, and failure of conservative treatment. Two children with intestinal obstruction had abnormal liver function tests preoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Internal hernias (particularly within the internal hernia triangle) are the predominant cause of post-CBD surgery obstruction. Cross-sectional imaging shows high diagnostic sensitivity. Given the higher likelihood of internal hernia as a cause of post-CBD surgery obstruction and its rapid progression to Roux limb necrosis, early surgical intervention should be considered.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1558884","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:01:07Z","timestamp":1742954467000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intestinal obstruction after surgery for congenital biliary dilatation in children: diagnosis and management"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhen-sheng","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Bian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"De-cheng","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi-qin","family":"Qi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1001\/jamasurg.2015.0226","article-title":"Presentation and clinical outcomes of choledochal cysts in children and adults","volume":"150","author":"Soares","year":"2015","journal-title":"JAMA Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jhbp.415","article-title":"Japanese clinical practice guidelines for congenital biliary dilatation","volume":"24","author":"Ishibashi","year":"2017","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B3","first-page":"Ch. 3","article-title":"Complications of bariatric surgery","volume-title":"Essentials and Controversies in Bariatric Surgery","author":"Kim","year":"2014"},{"key":"B4","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1007\/s00464-010-1183-y","article-title":"Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases","volume":"25","author":"Tang","year":"2011","journal-title":"Surg Endosc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/s00464-014-3667-7","article-title":"Laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts in China: a multicenter study","volume":"29","author":"Qiao","year":"2015","journal-title":"Surg Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1007\/s00383-009-2343-9","article-title":"Laparoscopic excision of choledochal cysts in children: an intermediate-term report","volume":"25","author":"Lee","year":"2009","journal-title":"Pediatr Surg Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1001\/jamasurg.2023.3211","article-title":"Abdominal pain after Roux-en-Y gastric bypass","volume":"158","author":"Fry","year":"2023","journal-title":"JAMA Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1007\/s00595-016-1319-3","article-title":"Laparoscopic management for prenatally diagnosed choledochal cysts","volume":"46","author":"Matsumoto","year":"2016","journal-title":"Surg Today"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1016\/j.jpedsurg.2012.09.001","article-title":"Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications","volume":"47","author":"Urushihara","year":"2012","journal-title":"J Pediatr Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1007\/s11605-010-1401-x","article-title":"Management strategies for internal hernia after gastric bypass","volume":"15","author":"O\u2019Rourke","year":"2011","journal-title":"J Gastrointest Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"3448","DOI":"10.1007\/s00330-020-06688-x","article-title":"Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass","volume":"30","author":"Ederveen","year":"2020","journal-title":"Eur Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/j.1432-2277.1997.tb00555.x","article-title":"Internal hernia and volvulus of the small bowel following liver transplantation","volume":"10","author":"Khanna","year":"1997","journal-title":"Transpl Int"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2106","DOI":"10.1007\/s11695-015-1672-0","article-title":"Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass","volume":"25","author":"Al-Mansour","year":"2015","journal-title":"Obes Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.amjsurg.2010.05.007","article-title":"Abdominal pain after gastric bypass: suspects and solutions","volume":"201","author":"Greenstein","year":"2011","journal-title":"Am J Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1007\/s00268-008-9582-0","article-title":"Choledochal cysts in children: epidemiology and outcomes","volume":"32","author":"Singhavejsakul","year":"2008","journal-title":"World J Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1007\/s11695-011-0364-7","article-title":"The four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction?","volume":"21","author":"Kawkabani Marchini","year":"2011","journal-title":"Obes Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1007\/s13304-021-01117-0","article-title":"Effect of hyaluronate-based bioresorbable membrane (Seprafilm) on outcomes of abdominal surgery: a meta-analysis and trial sequential analysis of randomised controlled trials","volume":"74","author":"Hajibandeh","year":"2022","journal-title":"Updates Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1001\/jamasurg.2023.1042","article-title":"Long-term safety and efficacy of closure of mesenteric defects in laparoscopic gastric bypass surgery","volume":"158","author":"Stenberg","year":"2023","journal-title":"JAMA Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/j.soard.2023.03.019","article-title":"American Society for metabolic and bariatric surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass","volume":"19","author":"Altieri","year":"2023","journal-title":"Surg Obes Relat Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.jpedsurg.2009.12.022","article-title":"A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study","volume":"45","author":"Diao","year":"2010","journal-title":"J Pediatr Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1186\/s40064-015-1556-8","article-title":"Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review","volume":"4","author":"Baba","year":"2015","journal-title":"SpringerPlus"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1558884\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:01:09Z","timestamp":1742954469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1558884\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":21,"alternative-id":["10.3389\/fped.2025.1558884"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1558884","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"article-number":"1558884"}}