Sump Syndrome: Endoscopic Treatment and Late Recurrence

Mavrogiannis, Christos; Liatsos, Christos; Romanos, Andreas; Goulas, Spyros; Dourakis, Spyros P.; Nakos, Antonios; Karvountzis, G.

doi:10.1111/j.1572-0241.1999.998_t.x

Cited by 20 publications

(6 citation statements)

References 16 publications

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“…Mesmo não havendo sinais de estenose da papilotomia realizada anteriormente, a presença de resíduos alimentares no coto distal pode sugerir que a papilotomia não resolveria permanentemente o problema de drenagem da via biliar distal, não impedindo que "Síndrome do Colédoco Distal" pudesse ocorrer nestes doentes. Mavrogiannis et al 28 , em 1999, demonstraram recorrência da síndrome em até 19,0% de 31 doentes submetidos à esfincterotomia endoscópica, em período médio de pós-operatório de 58,5 meses.…”

Section: Discussionunclassified

Modificação técnica da coledocoduodenostomia látero-lateral - análise dos resultados

Moricz¹,

Campos²,

Rêgo³

et al. 2004

Rev. Col. Bras. Cir.

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OBJETIVO: Avaliar se a oclusão do colédoco distal se mantém no decorrer do tempo, nos pacientes submetidos a coledocoduodenostomia látero lateral com oclusão do colédoco distal. MÉTODO: Foram analisados 14 doentes submetidos à coledocoduodenostomia látero-lateral modificada por Fava, para prevenir a "Síndrome do Colédoco Distal", tratados de coledocolitíase não complicada. Os doentes avaliados encontravam-se em pós-operatório que variou de três meses até dez anos após a derivação bílio-digestiva. Os doentes foram analisados do ponto de vista clínico através da classificação de Visick, submetidos à dosagem de transanimases (AST e ALT), enzimas canaliculares (gama-GT e fosfatase alcalina), bilirrubinas e ao exame de colangioressonância. Os doentes que apresentaram alguma alteração nos exames citados, foram submetidos à CPRE para avaliação definitiva da via biliar, identificação e tratamento de eventuais complicações da coledocoduodenostomia RESULTADOS: Em 11 doentes (78,6%) foi identificada abertura da oclusão do colédoco distal. Quatro doentes com menos de um ano de pós-operatório; quatro, entre um e cinco anos; e três doentes com mais de cinco anos de coledocoduodenostomia. Três doentes (21,4%) apresentaram "Sump Syndrome" no período de três meses, nove meses e oito anos de pós-operatório respectivamente, sendo tratados com sucesso através de papilotomia endoscópica. CONCLUSÕES: Nos doentes tratados de coledocolitíase não complicada a oclusão do colédoco distal na coledocoduodenostomia modificada por Fava et al, não se mantém patente no decorrer do tempo, não evitando o aparecimento da "Síndrome do Colédoco Distal".

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Section: Discussionunclassified

Modificação técnica da coledocoduodenostomia látero-lateral - análise dos resultados

Moricz¹,

Campos²,

Rêgo³

et al. 2004

Rev. Col. Bras. Cir.

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“…Sump syndrome occurs from bile stasis and reflux of duodenal contents into the biliary tree, resulting in cholangitis or hepatic abscess. Although the prevalence of sump syndrome is reported between 2.4 and 5% in previous studies, these cases can be managed safely and successfully with endoscopic procedure [4, 15, 16]. The rate of subsequent cholangitis after choledochoduodenostomy for benign obstruction is reported 0 to 1.1%, which is extremely lower than the rate after hepaticogastrostomy or drainage using plastic stent [9, 15, 17].…”

Section: Discussionmentioning

confidence: 99%

Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report

et al. 2017

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BackgroundDespite the improvements of surgical techniques and postoperative management of patients with liver transplantation, biliary complications are one of the most common and important adverse events. We present a first case of choledochoduodenostomy using magnetic compression following a massive resection of the small intestine due to strangulated ileus after living donor liver transplantation.Case presentationThe 54-year-old female patient had end-stage liver disease, secondary to liver cirrhosis, due to primary sclerosing cholangitis with ulcerative colitis. Five years earlier, she had received living donor liver transplantation using a left lobe graft, with resection of the extrahepatic bile duct and Roux-en-Y anastomosis. The patient experienced sudden onset of intense abdominal pain. An emergency surgery was performed, and the diagnosis was confirmed as strangulated ileus due to twisting of the mesentery. Resection of the massive small intestine, including choledochojejunostomy, was performed. Only 70 cm of the small intestine remained. She was transferred to our hospital with an external drainage tube from the biliary cavity and jejunostomy. We initiated total parenteral nutrition, and percutaneous transhepatic biliary drainage was established to treat the cholangitis. Computed tomography revealed that the biliary duct was close to the duodenum; hence, we planned magnetic compression anastomosis of the biliary duct and the duodenum. The daughter magnet was placed in the biliary drainage tube, and the parent magnet was positioned in the bulbus duodeni using a fiberscope. Anastomosis between the left hepatic duct and the duodenum was accomplished after 25 days, and the biliary drainage stent was placed over the anastomosis to prevent re-stenosis. Contributions to the successful withdrawal of parenteral nutrition were closure of the ileostomy in the adaptive period, preservation of the ileocecal valve, internal drainage of bile, and side-to-side anastomosis.ConclusionsCholedochoduodenostomy with magnet compression could be a less invasive and safer method for treatment of biliary stricture that cannot be accessed by conventional surgery.

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“…In our series of TDS, the recurrent cholangitis rate was 4/263 (1.5%) and the operative mortality rate was 4/263 (1.5%). The recommended treatment of sump syndrome is endoscopic sphincterotomy, though this procedure has its own morbidity and a restenosis rate as high as 19% [17], necessitating further papillotomy. By contrast the TDS stoma provides dependent drainage and very seldom requires reintervention.…”

Section: Discussionmentioning

confidence: 99%

Recurrent bile duct stones after transduodenal sphincteroplasty

Kibria

Hall

2002

HPB

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Sump Syndrome: Endoscopic Treatment and Late Recurrence

Abstract: We report a considerably high recurrence rate of sump syndrome after initially successful endoscopic management and its effective endoscopic treatment with a new papillotomy. We still believe that the primary therapeutic approach in patients with sump syndrome should be endoscopic.

Cited by 20 publications

References 16 publications

Modificação técnica da coledocoduodenostomia látero-lateral - análise dos resultados

Modificação técnica da coledocoduodenostomia látero-lateral - análise dos resultados

Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report

Recurrent bile duct stones after transduodenal sphincteroplasty

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