AHBPSAnnals of Hepato-Biliary-Pancreatic Surgery
www.ahbps.org S328
Hepatolithiasis long term complication of choledochal cyst resection: Rase report
Ana Isabel ARGUETA*, Francisco DE LEON, José CONTRERAS, Jimmy IXCAYAU, Haroldo PAIZ, Estuardo PORRAS, Erick SOTO Department of Surgery, Guatemala
EP-130
Introduction: Choledochal cysts (CCs) are uncommon with an incidence that ranges from 1 in 100,000–150,000 in Western popula- tions, to 1–1,000 in some Asian populations. The cyst can become complicated with stone disease, pancreatitis, cholangitis and malig- nancy of the biliary tree; therefore it has to be treated by operative resection of the bile duct, cholecystectomy, and biliodigestive recon- struction, irrespective of the age at presentation. In the long term follow up, postoperative intrahepatic stone and cholangitis present serious complications. Hepatolithiasis is likely to develop secondary to a postoperative anastomotic stricture.
Methods: We present a case report of a 23-year-old male with recurrent episodes of cholangitis and a past surgical history of complete choledocal cyst excision with bilioenteric anastomosis 16 years ago with no long term follow up. The diagnosis of anastomotic stenosis and hepatolithiasis was confirmed by magnetic resonance cholangiopancreatography. Percutaneous treatment was not possible. Pa- tient was taken to surgery where 28 bile stones were removed from choledoco, common hepatic and left hepatic duct. Intraoperative choledochoscopy confirmed stone clearance from the intrahepatic and extrahepatic ductal system. Biopsy was taken and a hepaticoje- junostomy according to Hepp-Couinaud performed.
Results: Biopsy reported negative for malignancy. Patient was discharged with no postoperative complications.
Conclusions: Close follow-up after CCs surgical treatment is important, moreover, these patients have a need for long term follow up to detect hepatolithiasis as soon as possible. Combined surgical procedure (stone extraction, on-table choledochoscopy and bilio-en- teric drainage) is an acceptable option for hepatolithiasis.
pISSN: 2508-5778ㆍeISSN: 2508-5859
Ann Hepatobiliary Pancreat Surg 2021;25 Suppl 1:S328 https://doi.org/10.14701/ahbps.EP-130
Corresponding Author: Ana Isabel ARGUETA (aiarguetacontreras@gmail.com) Presenter: Ana Isabel ARGUETA (aiarguetacontreras@gmail.com)
Copyright Ⓒ The Korean Association of Hepato-Biliary-Pancreatic Surgery
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
