Modified hepaticojejunostomy for permanent biliary access

Krige, J. E. J.; Bornman, P. C.; Harries-Jones, E.P.; Terblanche, J.

doi:10.1002/bjs.1800740725

Cited by 20 publications

(11 citation statements)

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“…Drainage procedures like T-tube drainage, choledochoduodenostomy, hepaticojejunostomy or even pancreaticojejunostomy may have to be resorted in different situations (15). In cases where repeated explorations have been performed for biliary ascariasis, an access loop hepaticocutaneous jejunostomy may be needed for dealing with recurrent lithiasis (19).…”

Section: Discussionmentioning

confidence: 99%

Hepato- Biliary Ascariasis- Experience from a Tertiary Care Hospital in North East India

Hajong¹

2013

IOSR-JDMS

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Section: Discussionmentioning

confidence: 99%

Hepato- Biliary Ascariasis- Experience from a Tertiary Care Hospital in North East India

Hajong¹

2013

IOSR-JDMS

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“…A bile duct reconstruction was performed, bringing together the separated adjacent walls of the right and left hepatic ducts together and suturing them to form a common wall. The bilio-enteric anastomoses were then performed over separate externalised stents via a modified Terblanche Roux-en-Y limb [ 7 ]. The anastomoses on subsequent imaging gave the appearance of a preserved confluence, because of the sutured common adjoining walls of the right and left separated ducts.…”

Section: Case Presentationmentioning

confidence: 99%

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation

et al. 2015

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BackgroundRight hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 – 61% of cases when routine angiography is employed following a BDI.We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction. This is on a background of biliary reconstruction following a major BDI.Case presentationA 37-year old man underwent a bile duct reconstruction following a major BDI (Strasberg-Bismuth E4 injury) sustained at laparoscopic cholecystectomy. He had two separate bilio-enteric anastomoses of the right and left hepatic ducts and had a modified Terblanche Roux-en-Y access limb formed.Approximately three weeks later he was admitted for significant gastrointestinal bleeding and was hypotensive and anaemic. Selective computed tomography angiography revealed a 2 x 2 centimetre right hepatic artery pseudoaneurysm, which was urgently embolised with radiological coils.Two months later he developed intermittent fevers, rigors, jaundice, and right upper quadrant pain with evidence of intrahepatic biliary dilatation on magnetic resonance cholangiopancreatography. The degree of intrahepatic biliary dilatation progressively increased on subsequent imaging over several months, suggesting stricturing of the bilio-enteric anastomoses. Several attempts to traverse these strictures with a percutaneous transhepatic approach had failed. Then, approximately ten months after the initial BDI repair, choledochoscopy through the Terblanche access limb revealed multiple radiological coils within the bilio-enteric anastomoses, which had eroded from the previously embolised right hepatic artery. A laparotomy was performed to remove the coils, take down the existing obstructed bilio-enteric anastomoses and revise this. Following this the patient recovered uneventfully.ConclusionObstructive jaundice and cholangitis secondary to erosion of angiographically placed embolisation coils is a rarely described complication. In view of the relative frequency of arterial injury and complications following major bile duct injury, we suggest that these patients be formally assessed for associated arterial injury following a major BDI.

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“…c showing infant feeding catheters in separate ducts) as well as an injury to a tributary of the right hepatic vein (demonstrated on injection of contrast into a ductal structure). She underwent an intrahepatic cholangiojejunostomy (modified Longmire procedure) with a retrocolic Roux‐en‐Y reconstruction and medial access limb (Terblanche procedure). An enterotomy was made in the antimesenteric border of jejunum to sufficiently cover all exposed ducts sufficiently from the stapled end to allow for an access limb.…”

mentioning

confidence: 99%

“…In this case, transection of the right hepatic duct with exposure of three leaking hepatic ducts occurred, necessitating a modified Longmire approach. The original Longmire I method involves side‐to‐side biliary‐enteric anastomosis with enteroenterostomy to a retrocolic loop of jejunum with a layer of absorbable sutures (Fig. d).…”

mentioning

confidence: 99%