Cholangitis many years after choledochoduodenostomy

Don’t Forget about the Sump! An Uncommon Complication Many Years after a Choledochoduodenostomy

“…The clinical presentation is non-specific, it varies most of the time, but is recurrent. Within the symptoms, we can find pain in the right upper quadrant, jaundice, fever and other findings that correspond with cholangitis, liver abscesses, and pancreatitis plus other stemming complications [1][2][3][4][5]11]. Among the imaging studies that are helpful for the diagnosis, we find, depending on accessibility, US, TC, and MRI.…”

“…Bilioenteric anastomoses were common procedures until the advent of endoscopic methods, specifically ERCP [1]. Among the indications for performing a CDS we can find choledocholithiasis unresolved by ERCP or bile duct exploration, benign biliary strictures, malignant neoplasms of the biliopancreatic tract, and even biliary reconstructions for transplants [5,7]. Nowadays, in the era of laparoendoscopic procedures, bilioenteric anastomoses are rarely used as first-line treatment choices, and their complications, including SS, are scarcely found [8].…”

“…4). Consequently sludge or food debris trapped in this non-functional reservoir above the papilla results in bacterial infections, biliary stasis, formation of new gallstones, and even dysplastic changes in the mucosa of the common bile duct [3,5,10]. The clinical presentation is non-specific, it varies most of the time, but is recurrent.…”

“…Nowadays, in the era of laparoendoscopic procedures, choosing CDS as a first-line treatment is unheard of and its complications, including SS, are almost forgotten, mainly due to the large time interval between procedure and the syndrome's appearance. The primary diagnosis as well as the treatment can be conducted, most of the time, endoscopically by ERCP [5,6].…”