Is It Really SUMP Syndrome? A Case Report

Abstract

Sump syndrome is a rare, long-term complication with a prevalence ranging from 0% to 9.6% in patients with a history of side-to-side choledochoduodenostomy. Choledochoduodenostomy was originally performed to achieve drainage of the common bile duct in high-risk patients with low morbidity, which was commonly done in the pre-endoscopic retrograde cholangiopancreatography era. “Sump” comes from the segment of the common bile duct between the anastomosis and the ampulla of Vater, which acts as a stagnant reservoir for debris, stones, and static bile. This predisposes patients to changes in the biliary tree with signs and symptoms in relation to that area. If left untreated, cholangitis, pancreatitis, hepatic abscesses, and secondary biliary cirrhosis can develop. Here, we have a case of a 77-year-old male with a history significant for choledochoduodenostomy, who presented with the clinical signs and symptoms of pancreatitis, choledocholithiasis, and urinary tract infection. Computed tomography (CT) scan findings revealed choledocholithiasis and an enlarged common bile duct with smaller adjacent calculi along with pneumobilia consistent with sump syndrome. The patient’s clinical status improved without invasive measures being taken, i.e. endoscopic retrograde cholangiopancreatography. He was subsequently discharged home after improving clinically and no invasive measures were pursued.

Recurrent cholangitis after choledochoduodenostomy: A case report

“…However, ERCP was not carried out in this instance since a diagnosis of sump syndrome was confirmed, and the treatment concepts include cleaning, removing, and reattaching the distal stump. Thus, open surgery, namely choledochojejunostomy, was the preferred method [11] .…”

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

“…This syndrome is an infrequent complication of the CDS with a reported prevalence of 0–9.6%; classically it occurred more frequently after a side-to-side CDS; however, there is no difference reported with the side-to-end variation [ 2 ].…”

“…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.…”

“…Sump syndrome (SS) is a scarcely known medical condition; it is a rare complication of bilioenteric anastomosis performed previously to the era of endoscopic treatments such as endoscopic retrograde cholangiopancreatography (ERCP). Studies have shown that it has a prevalence ranging from 0 to 9.6%, being more frequent after performing a choledochoduodenostomy (CDS) [ 1 , 2 ].…”

“…Sump syndrome (SS) is a scarcely known medical condition; it is a rare complication of bilioenteric anastomosis performed previously to the era of endoscopic treatments such as endoscopic retrograde cholangiopancreatography (ERCP). Studies have shown that it has a prevalence ranging from 0 to 9.6%, being more frequent after performing a choledochoduodenostomy (CDS) [1,2]. This syndrome is not entirely defined; it results from the accumulation of lithogenic bile, cellular detritus, and gallstones as well as reflux of the duodenal content in the distal part of the common bile duct that has an inefficient drainage -the sump -which results in biliary and pancreatic complications [3,4].…”