A case of postoperative recurrent cholangitis after pancreaticoduodenectomy successfully treated by tract conversion surgery

Shiihara, Masahiro; Miura, Osamu; Konishi, Kozo; Takeo, Sachiko; Kakimoto, Tadatoshi; Hidaka, Gen; Shibui, Yuichi; Minamisono, Yoshikazu; Toda, Tomohiro; Uemura, Shuichiro; Yamamoto, Masakazu

doi:10.1093/jscr/rjw123

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…Some studies have suggested that a longer afferent loop or Roux-en-Y limb is a factor that prevents reflux and stasis in patients with biliary reconstruction [ 15 , 16 ], but there are also reports that shorter limb lengths are associated with fewer complications, so a certain view has not been reached [ 17 ]. In this case, the indication for surgery was also determined after careful consideration, referring to previous cases in which surgery was performed for nonobstructive retrograde cholangitis that developed after biliary reconstruction surgery [ 4 , 5 , 18 , 19 ]. The procedure was determined with reference to the Roux-en-Y extension to increase the distance between the route of oral intake and the bile duct jejunal anastomosis, among others [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of postoperative nonobstructive recurrent cholangitis by tract conversion surgery after total pancreatectomy: a case report

et al. 2023

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Background Postoperative cholangitis is a complication of biliary reconstruction during hepatobiliary pancreatic surgery. Most cases are associated with anastomotic stenosis, but there are also cases of cholangitis without stenosis, and treatment can be difficult, especially in patients with recurrent symptoms. In this report, we describe a case of repeated nonobstructive cholangitis in a patient after total pancreatectomy, in which a good outcome was obtained after performing tract conversion surgery. Case presentation The patient was a 75-year-old man. He underwent total pancreatectomy for stage IIA cancer of the pancreatic body, hepaticojejunostomy via the posterior colonic route, gastrojejunostomy and Braun anastomosis via the anterior colonic route using the Billroth II method. The patient had a good postoperative course and was receiving adjuvant chemotherapy on an outpatient basis, but he developed his first episode of cholangitis 4 months after surgery. Although conservative treatment with antimicrobial agents was successful, the patient continued to have recurrent biliary cholangitis and was repeatedly admitted and discharged from the hospital. Since stenosis at the anastomosis was suspected, endoscopic observation of the anastomosis was performed using small bowel endoscopy for close examination, but no apparent stenosis was observed. Small bowel imaging indicated a possible influx of contrast medium into the bile duct, and reflux due to food residue was suspected as the cause of cholangitis. Since conservative treatment alone did not suppress the flare-up of symptoms, the decision was made to perform tract conversion surgery for curative purposes. The afferent loop was cut midstream, and jejunojejunostomy was performed downstream. The postoperative course was good, and the patient was discharged on the 10th day after surgery. He is currently an outpatient and has been free of cholangitis symptoms for 4 years without cancer recurrence. Conclusions Although the diagnosis of nonobstructive retrograde cholangitis can be difficult, surgical treatment should be considered in patients with recurrent symptoms and refractory treatment.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of postoperative nonobstructive recurrent cholangitis by tract conversion surgery after total pancreatectomy: a case report

et al. 2023

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“…Two clinical cases of this kind were presented by Japanese authors. In one case, it was necessary to convert the reconstructive scheme from the Imanagi to the Child method 13 years after the PD [18] with a good immediate result. In the second patient, recurrent reflux-cholangitis began to appear soon after PD.…”

Section: Discussionmentioning

confidence: 99%

“…Up to 2016, Virgilio et al [9] found only 35 cases fulfilling the definition of merely post-surgical PLA [7,10–11]. We add to them a number of cases – both in earlier [5,8,12–17] and later [18,19] publications. There are only two papers analyzing the problem of post-PD liver abscesses on large clinical material [10,19].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, in the vast majority of such patients, PLA does not develop in the early postoperative period, but after discharge – weeks and months after PD [W. Chen, 2019, personal communication]. In some papers, the occurrence of PLA in very late periods – 3 years [17], 3.5 years [12], 9 years [11], and 10 years [18] after PD was described. Such cases are of considerable interest from the point of view of etiological features and the optimal treatment of the developed PLA.…”

Section: Introductionmentioning

confidence: 99%

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Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy

et al. 2019

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Patient: Male, 42 Final Diagnosis: Ruptured liver abscess • local peritonitis Symptoms: Severe abdominal pain • fever with a body temperature of 39°C • jaundice and severe weakness Medication: — Clinical Procedure: Laparotomy, drainage of the liver abscess Specialty: Surgery Objective: Rare co-existence of disease or pathology Background: Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. Case Report: A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40 th day and the subdiaphragmatic drains were removed on the 114 th day. Sixteen months after surgery, the patient’s condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. Conclusions: A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.

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“…Postoperative benign biliary stenosis at the anastomotic site is one of the most common complications [ 6 – 8 ]. Reoperation or dilation of stenosis through the percutaneous transhepatic biliary drainage route has usually been performed, but these are invasive and negatively influence the quality of life.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Hepaticogastrostomy Is Effective for Repeated Recurrent Cholangitis after Surgery: Two Case Reports

Matsumi

Kato

Saragai

et al. 2018

Case Reports in Gastrointestinal Medicine

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We report the cases of two patients who underwent endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using metallic stents (MS) for recurrent cholangitis due to benign biliary stenosis. The patients had repeatedly undergone double-balloon endoscopy and anastomotic stenosis. Thus, EUS-HGS was performed. The procedures were successful, and placement of a covered metallic stent (C-MS) relieved cholangitis. The occurrence of cholangitis was subsequently considerably reduced. For patients with postoperative recurrent cholangitis, EUS-HGS with MS should be considered because of its efficacy and safety.

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A case of postoperative recurrent cholangitis after pancreaticoduodenectomy successfully treated by tract conversion surgery

Cited by 4 publications

References 9 publications

Successful treatment of postoperative nonobstructive recurrent cholangitis by tract conversion surgery after total pancreatectomy: a case report

Successful treatment of postoperative nonobstructive recurrent cholangitis by tract conversion surgery after total pancreatectomy: a case report

Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy

Endoscopic Ultrasound-Guided Hepaticogastrostomy Is Effective for Repeated Recurrent Cholangitis after Surgery: Two Case Reports

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