Proximal Roux-en-Y Limb Intussusception After Pediatric Living Donor Liver Transplantation for Biliary Atresia: A Rare Surgical Emergency.

BACKGROUND: Intussusception of the Roux-en-Y limb after pediatric liver transplantation (LT) is an extremely rare but potentially life-threatening complication. Altered anatomy, postoperative adhesions, and disrupted intestinal motility create a unique pathophysiological environment, which may delay diagnosis and increase morbidity. METHODS: We retrospectively analyzed a patient with acute intestinal obstruction after living donor liver transplantation. Clinical presentation, laboratory findings, imaging results, intraoperative observations, surgical management, and outcomes were reviewed. The potential pathogenesis was explored in relation to factors such as Roux-en-Y reconstruction, graft-to-recipient size ratio, and postoperative adhesive disease. RESULTS: The patient presented with fever and melena. Laboratory evaluation revealed leukocytosis and severe anemia. Computed tomography demonstrated small bowel intussusception with obstruction. Emergency laparotomy identified intussusception of the proximal Roux limb near the biliary-enteric anastomosis. Manual reduction was unsuccessful, necessitating segmental resection without reconstruction of a new Roux limb. Extensive intra-abdominal adhesions were noted. Postoperative recovery was uneventful, and graft function remained stable. CONCLUSIONS: Intussusception of the Roux-en-Y limb following pediatric living donor liver transplantation is a complex surgical emergency. This case demonstrates that in the transplant population, symptoms such as fever and melena should trigger immediate cross-sectional imaging to rule out mechanical obstruction. The management strategy must be aggressive yet conservative regarding anatomical disruption. As the population of long-term pediatric transplant survivors grows, recognizing these distinct mechanistic patterns is essential for reducing morbidity and mortality.