Roux-en-Y on-line intussusception to avoid ascending cholangitis in biliary atresia.

A child with biliary atresia experienced severe ascending cholangitis when the exteriorized loop of a portahepatoenterostomy was internalized. Backwash of bowel contents was reduced and further cholangitis was prevented by creation of an on-line intussuscepted Roux-en-Y jejunal loop to provide a nonrefluxing conduit from the porta hepatis. The loop could then be internalized and antibiotic therapy could be discontinued. The success of this procedure in this case encourages us to use this method in similar cases of biliary atresia. It may be of use in all Roux-en-Y loops, such as those used to drain the transplanted liver of patients with biliary atresia and those created to drain the distal part of the transplanted pancreas.