Choledochoduodenostomy stent occlusion

Case contributed by Dr Dalia Ibrahim

Presentation

History of cholecystectomy years ago which was complicated by CBD ligation. The patient was subsequently treated with a choledochoduodenostomy, after which she developed a stricture at the anastomotic site. A stent was applied at the anastomotic site. Now she is complaining of jaundice.

Patient Data

Age: 50 years
Gender: Female

Status post cholecystectomy, choledochoduodenostomy, and stent application showed:

  • Marked intra- and extra-hepatic biliary radicle dilatation down to the anastomotic site. The applied stent is seen within the anastomotic site showing rather in an oblique orientation. The dilated proximal CBD and the proximal hepatic ducts show intraluminal biliary sludge and debris showing an intermediate signal on T2 WI.
  • The CBD distally is collapsed.
  • Normal MRI signal of the pancreas. The pancreatic duct is not dilated.
  • Multiple enlarged porta-hepatis, porto-caval, and peripancreatic lymph nodes.

 

Case Discussion

The patient had a history of cholecystectomy a long period ago which was complicated by CBD ligation. The patient later was treated with choledochoduodenostomy, which was also complicated by a stricture at the anastomotic site. That was treated by stent application at the choledochoduodenostomy anastomotic site.

The patient later developed severe jaundice and MRCP revealed marked biliary dilatation down to the anastomotic site and suspected stent dysfunction/occlusion. That was confirmed and treated by ERCP with the replacement of the applied stent by another patent one.

Choledochoduodenostomy is a surgical procedure to create an anastomosis between the CBD and the duodenum.

Indications of choledochoduodenostomy:

  • Choledocholithiasis
  • CBD injury or stricture
  • Ampullary stenosis.
  • Chronic pancreatitis
  • Malignant neoplasms involving or compressing the CBD

Complications

  • Short term
    • Bile leakage
  • Long term

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