An Impassable Artificial Intestinal Valve during Double-Balloon Enteroscopy for Recurrent Cholangitis 18 Years after Choledochal Cyst Excision
- 1Division of Pediatric SurgeryDepartment of Surgery Asahikawa Medical University Asahikawa Hokkaido Japan
- 2Division of GastroenterologyDepartment of Internal Medicine Asahikawa Medical University Asahikawa Hokkaido Japan
Abstract
Congenital biliary dilatation (formerly referred to as choledochal cyst) is a congenital anomaly characterized by cystic dilatation of the bile ducts. Historically, an artificial intestinal valve (AIV) was sometimes added to Roux-en-Y reconstruction to prevent postoperative reflux cholangitis, but its clinical significance remains controversial. We report the case of an 18-year-old man who underwent excision of congenital biliary dilatation and Roux-en-Y hepaticojejunostomy with an AIV during infancy. He developed recurrent cholangitis from 16 years of age. Magnetic resonance cholangiopancreatography showed mild intrahepatic bile duct dilatation and a microabscess in segment 5. Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography was performed for biliary evaluation. However, the endoscope could not pass through the severely narrowed orifice of the AIV, which meant that reaching the hepaticojejunostomy was impossible. His symptoms improved with conservative antibiotic treatment, and no further cholangitis has occurred. He subsequently transitioned to the adult Gastroenterology Department and undergoes annual imaging follow-up. While AIVs are introduced to prevent reflux, recent studies have suggested that postoperative cholangitis is multifactorial. In this case, the AIV became a critical obstacle to endoscopic access approximately 20 years postoperatively. With advancements in double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography, securing future endoscopic access is increasingly important. An AIV can hinder endoscopic biliary access after congenital biliary dilatation surgery, and our institution has since discontinued its use.
Related
- Breaking the compatibility barrier: cholangioscopy-guided laser lithotripsy during enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y anatomy.
- Adult choledochal cyst resection in Scandinavia: uncommon malignancy and considerable morbidity in a multicentre surgical cohort.
- Concordancia diagnóstica entre la cápsula endoscópica y la enteroscopía de doble balón en la hemorragia digestiva de intestino medio en un hospital de referencia en Perú Diagnostic Agreement Between Capsule Endoscopy and Double-Balloon Enteroscopy in Mid-Gut Gastrointestinal Bleeding at a Referral Hospital in Peru
- Totally single-incision laparoscopic choledochal cyst excision with intracorporeal hand-sewn Roux-en-Y reconstruction in children: clinical outcomes and learning curve.
- Five critical blind spots limiting translational progress in primary sclerosing cholangitis.
BibTeX
@article{kumata2026impassable,
title = {{An Impassable Artificial Intestinal Valve during Double-Balloon Enteroscopy for Recurrent Cholangitis 18 Years after Choledochal Cyst Excision}},
author = {Yuka Kumata and Tetsuhiro Okada and Minori Ishii and Saya Azuma and Yuki Meya and Hisayuki Miyagi},
journal = {European Journal of Pediatric Surgery Reports},
year = {2026},
month = oct,
doi = {10.1055/a-2979-4687},
url = {https://doi.org/10.1055/a-2979-4687},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - An Impassable Artificial Intestinal Valve during Double-Balloon Enteroscopy for Recurrent Cholangitis 18 Years after Choledochal Cyst Excision
AU - Yuka Kumata
AU - Tetsuhiro Okada
AU - Minori Ishii
AU - Saya Azuma
AU - Yuki Meya
AU - Hisayuki Miyagi
PY - 2026
DA - 2026/10/22
JO - European Journal of Pediatric Surgery Reports
DO - 10.1055/a-2979-4687
UR - https://doi.org/10.1055/a-2979-4687
AB - Congenital biliary dilatation (formerly referred to as choledochal cyst) is a congenital anomaly characterized by cystic dilatation of the bile ducts. Historically, an artificial intestinal valve (AIV) was sometimes added to Roux-en-Y reconstruction to prevent postoperative reflux cholangitis, but its clinical significance remains controversial. We report the case of an 18-year-old man who underwent excision of congenital biliary dilatation and Roux-en-Y hepaticojejunostomy with an AIV during infancy. He developed recurrent cholangitis from 16 years of age. Magnetic resonance cholangiopancreatography showed mild intrahepatic bile duct dilatation and a microabscess in segment 5. Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography was performed for biliary evaluation. However, the endoscope could not pass through the severely narrowed orifice of the AIV, which meant that reaching the hepaticojejunostomy was impossible. His symptoms improved with conservative antibiotic treatment, and no further cholangitis has occurred. He subsequently transitioned to the adult Gastroenterology Department and undergoes annual imaging follow-up. While AIVs are introduced to prevent reflux, recent studies have suggested that postoperative cholangitis is multifactorial. In this case, the AIV became a critical obstacle to endoscopic access approximately 20 years postoperatively. With advancements in double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography, securing future endoscopic access is increasingly important. An AIV can hinder endoscopic biliary access after congenital biliary dilatation surgery, and our institution has since discontinued its use.
SN - 2194-7619
SN - 2194-7627
ER -