Severe constipation-associated postprandial abdominal pain in a pregnant native-liver biliary atresia survivor after Kasai portoenterostomy: A case report.

Abstract

An 18-year-old woman with congenital biliary atresia status post Kasai portoenterostomy and magnetic resonance imaging-reported chronic liver disease presented at 32 weeks' gestation with 6 weeks of worsening postprandial epigastric/right upper quadrant pain, nausea, and poor oral intake. Evaluation showed preserved hepatic synthetic function and no demonstrated clinically significant portal hypertension. Endoscopy excluded esophageal and gastric varices, computed tomography showed no imaging evidence of pancreatitis, biliary obstruction, or other acute intra-abdominal pathology, computed tomography angiography excluded mesenteric ischemia, and gastric emptying scintigraphy excluded gastroparesis. Nonreassuring fetal surveillance prompted preterm induction at approximately 33 weeks 4 days. Postpartum symptoms persisted, and imaging review identified severe constipation with rectal impaction/fecalization as the dominant treatable contributor. This case broadens the peripartum phenotype reported in native-liver biliary atresia survivors by emphasizing constipation-associated postprandial abdominal pain, poor oral intake, nutritional risk, and medication-related bowel dysfunction rather than variceal bleeding or hepatic decompensation alone.