Benign stenosis of common bile duct after Roux Y gastrectomy
Authors:
M. Piter 1; J. Klein 1,2; B. Tolmáči 1; J. Maňák 3
Authors‘ workplace:
Chirurgické oddělení, Krajská nemocnice Tomáše Bati, Zlín
1; Fakulta zdravotníctva, Trenčianská Univerzita Alexandera Dubčeka, Trenčín
2; III. interní gerontometabolická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy
3
Published in:
Rozhl. Chir., 2022, roč. 101, č. 7, s. 332-336.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.7.332–336
Overview
We present the case of a 60-year-old patient with the history of subtotal gastric resection and reconstruction of passage using the Roux-Y loop, five years later diagnosed with benign stenosis of the common bile duct. The possibilities of using endoscopy and interventional radiology for the bile duct treatment in the postoperatively altered terrain of the proximal digestive tract were limited. After failure of these methods the patient was indicated for surgery – biliodigestive anastomosis. The postoperative course was significantly complicated by bleeding and formation of bile and colic fistulas. Over time, a migrated stent was found in the small intestine, which was the cause of inflammatory changes and incomplete small bowel obstruction. Increased intraluminal pressure in the intestinal loops inhibited healing of the anastomosis and was a major cause of the complications.
Keywords:
choledochoduodenostomy – biliocutaneous fistula – migrated transhepatic drain
Sources
1. Skalický T, Třeška V, Sutnar A, et al. Nenádorové stenózy žlučových cest. Rozhl Chir. 2011,90(8):446–449.
2. Nakai Y, Isayama H, Wang HP, et al. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol. 2020 Jun;35(6):967–979. doi:10.1111/ jgh.14955.
3. Mita MT, Dalmonte G, Gnocchi A, et al. Transjejunal laparoscopic-assisted ERCP in Roux-en-Y patient: the new right path. Ann R Coll Surg Engl. 2019;101(2):e45–e47.
4. Wisneski AD, Carter J, Nakakura EK, et al. Ampullary stenosis and choledocholithiasis post Roux-En-Y gastric bypass: challenges of biliary access and intervention. HPB (Oxford). 2020 Oct;22(10):1496– 1503. doi:10.1016/j.hpb.2020.02.004.
5. Azevedo F, Canhoto C, Tralhão JG, et al. Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis. BMJ Case Rep. 2020 Jan 5;13(1):e232498. doi:10.1136/bcr-2019- 232498.
6. Chavalitdhamrong D, Draganov PV. Endoscopic ultrasound-guided biliary drainage. World J Gastroenterol. 2012;18(6):491–497. doi:10.3748/wjg. v18.i6.491.
7. Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy. 2007 Dec;39(12):1068–1071. doi:10.1055/s-2007-966841.
8. Dellon ES, Kohn GP, Morgan DR, et al. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci. 2009 Aug;54(8):1798–17803. doi:10.1007/ s10620-008-0538-x.
9. De Koning M, Moreels TG. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Rouxen- Y small bowel surgery. BMC Gastroenterol. 2016;16(1):98. doi:10.1186/s12876- 016-0512-6.
10. Okamoto H, Miura K, Itakura J, et al. Current assessment of choledochoduodenostomy: 130 consecutive series. Ann R Coll Surg Engl. 2017 Sep;99(7):545–549. doi:10.1308/rcsann.2017.0082.
11. Hsien-Tzu L, Hsiuo Shan T, Nai Chi C, et al. Percutaneous transhepatic techniques for retrieving fractured and intrahepatically dislodged percutaneous transhepatic biliary drainage catheters. Diagn Interv Radiol. 2017 Nov-Dec;23(6):461–464. doi 10.5152/dir.2017.17064.
12. Kwan JR, Low KSH, Lohan R, et al. Percutaneous transhepatic biliary drainage catheter fracture: A case report. Ann Hepatobiliary Pancreat Surg. 2018 Aug;22(3):282– 286. doi:10.14701/ahbps.2018.22.3.282.
13. Zorbas KA, Ashmeade S, Lois W, et al. Small bowel perforation from a migrated biliary stent: A case report and review of literature. World J Gastrointest Endosc. 2021;13(10):543–554. doi:10.4253/wjge. v13.i10.543.
14. Park TY, Hong SW, Oh HC, et al. Colonic diverticular perforation by a migrated biliary stent: A case report with literature review. Medicine (Baltimore) 2021 Dec 30;100(52). doi:10.1097/ MD.0000000000028392.
15. Issa H, Nahawi M, Bseiso B, et al. Migration of a biliary stent causing duodenal perforation and biliary peritonitis. World J Gastrointest Endosc. 2013 Oct 16;5(10):523– 526. doi:10.4253/wjge.v5.i10.523.
16. Yaprak M, Mesci A, Colak T, et al. Biliary stent migration with duodenal perforation. Eurasian J Med. 2008 Dec;40(3):154– 156.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2022 Issue 7
Most read in this issue
- Diagnosis and treatment of surgical skin and soft tissue infections – current status
- Giant aggressive intra-abdominal desmoid-type fibromatosis – case report
- Laparoscopic repair of perforated peptic ulcer – routine procedure or targeted patient selection?
- Benign stenosis of common bile duct after Roux Y gastrectomy