# Kasai-Like Hepaticojejunostomy As Salvage Reconstruction for Bile Duct Injury in an Infant: A Case Report and Technical Consideration

## TL;DR

A modified surgical technique, inspired by the Kasai procedure, was successfully used to repair a tiny bile duct injury in an infant when standard methods were not possible.

## Contribution

The paper introduces a novel surgical adaptation for iatrogenic bile duct injury in infants with ultra-thin ducts.

## Key findings

- A Kasai-like hepaticojejunostomy was successfully performed for a <1 mm bile duct injury in an infant.
- The procedure resulted in uneventful postoperative recovery with no bile leakage.
- The technique may serve as a salvage option when conventional biliary reconstruction is not feasible.

## Abstract

Bile duct injury (BDI) in children is an uncommon yet serious complication after hepatobiliary surgery or trauma. Management is particularly challenging because of the extremely small caliber of infantile bile ducts, which makes conventional biliary reconstruction technically difficult. Standard approaches are often not feasible when the injury occurs at the hilar level or involves ultra-thin ducts. In such cases, alternative surgical strategies are required. A Kasai-like hepaticojejunostomy- an approach analogous to the portoenterostomy used in biliary atresia- may serve as a salvage option when standard hepaticojejunostomy is technically impossible. We report a one-year-old boy with multiple congenital anomalies and hepatoblastoma involving segments 4 and 6 who underwent right hepatic trisectionectomy. During hilar dissection, an inadvertent pin-hole injury to the common bile duct (<1 mm diameter) was encountered, precluding standard reconstruction. A Kasai-type salvage was performed: the bile duct incision was extended proximally to the left duct, a 3-Fr transanastomotic stent was inserted, and a Roux-en-Y jejunal limb was directly anastomosed to the transected hepatic surface. Postoperative recovery was uneventful, with no bile leakage. The stent was removed three months later, and pathology confirmed complete resection of hepatoblastoma. This case demonstrates the feasibility of Kasai-like hepaticojejunostomy as a selective salvage procedure for iatrogenic hilar bile duct injury in infants. While the successful outcome in this single case is encouraging, it is important to recognize that this approach was necessitated by extreme anatomical constraints that precluded conventional reconstruction. When duct size makes standard hepaticojejunostomy technically impossible, this technique offers a safe alternative; however, further evaluation is needed to establish its long-term role compared to standard methods.