title: Urgent living donor liver transplantation for biliary atresia complicated by a strangulated internal hernia at Roux-en Y limb: a case report.
abstract: BACKGROUND
  When BA patients with end-stage liver dysfunction have bowel obstruction, especially strangulated internal hernia, selecting optimal surgical therapeutic options is crucial.
  
  
  METHODS
  An 11-month-old female with end-stage biliary atresia (BA) was admitted for a strangulated internal hernia at the Roux-en Y limb and frequent episodes of gastrointestinal bleeding requiring blood transfusion. She was scheduled within a month to receive a portion of the liver from her blood-type identical mother. Despite intensive care, her clinical condition obviously needed a prompt surgical intervention. The operative findings at laparotomy revealed exudative moderate ascites and a dilated and ischemic afferent loop that was strangulated by a band extending from the mesentery to the transverse mesocolon. The attachment of the band was released, and gangrenous changes were recognized in the incarcerated bowel, although there were no obvious findings of intestinal perforation. After the gangrenous afferent loop was resected, the remnant afferent loop was too short to anastomose again. Following these procedures, as the patient's vital signs remained stable, we decided to simultaneously perform living donor liver transplantation (LDLT). She successfully underwent LDLT and her post-transplant course was uneventful.
  
  
  CONCLUSIONS
  When faced with candidates for LT as an urgent life-saving surgery, determining whether LDLT should be performed simultaneously during perioperative management is necessary to save the life of the patient.
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Ikumi
authors.initials: I
authors.lastname: Hamano
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kitajima
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D000713:Anastomosis, Roux-en-Y; D001656:Biliary Atresia / Q000150:complications* / Q000601:surgery*; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D012720:Severity of Illness Index