Revision of the common bile duct in a combined PTCD/ERC approach - A case report

A Kleinwort; K R Liedtke; A Schreiber; R Keßler; A Glitsch

doi:10.1016/j.ijscr.2021.105854

Revision of the common bile duct in a combined PTCD/ERC approach - A case report

Int J Surg Case Rep. 2021 May:82:105854. doi: 10.1016/j.ijscr.2021.105854. Epub 2021 Apr 1.

Authors

A Kleinwort¹, K R Liedtke², A Schreiber², R Keßler³, A Glitsch²

Affiliations

¹ Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany. Electronic address: Annabel.Kleinwort@med.uni-greifswald.de.
² Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany.
³ Institute of Diagnostic Radiology and Neuroradiology, Universitätsmedizin Greifswald, Greifswald, Germany.

Abstract

Introduction and importance: The endoscopic retrograde cholangiography (ERC) represents the standard treatment for choledocholithiasis. However, ERC in patients with previous gastrectomy and anastomosis is difficult due to altered access.

Case presentation: In our case, we report on a patient with previous gastrectomy and Y-Roux-anastomosis suffering from choledocholithiasis. Operative revision with simultaneous cholecystectomy failed. In a combined procedure of percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic cholangiography the stone removal of the common bile duct was finally successful.

Clinical discussion: There are some approaches for treatment of choledocholithiasis in pre-operated patients. However, prospective multi-center studies for complication and success rates are not available due to the rarity of such cases.

Conclusion: Interdisciplinary procedures seem to be the safest and most promising way to succeed in the treatment of choledocholithiasis in challenging cases.

Keywords: Case report; Cholangiography; Choledocholithiasis; Gastrectomy; Percutaneous transhepatic cholangiodrainage.