Utility of hepatobiliary scintigraphy for recurrent reflux cholangitis following choledochojejunostomy: A case report. (2018)

• Record Type: Journal Article
• Authors: Yamamoto, Masateru; Tahara, Hiroyuki; Hamaoka, Michinori; Shimizu, Seiichi; Kuroda, Shintaro; Ohira, Masahiro; Ide, Kentaro; Kobayashi, Tsuyoshi; Ohdan, Hideki
• Is Part Of: International journal of surgery case reports. Volume 42(2018)
• Page Start: 104
• Page End: 108
• Publication Date: 2018
• Subjects: ICC intrahepatic cholangiocarcinoma -- CT computed tomography -- S7 segment 7; Blind loop -- Choledochojejunostomy -- Hepatobiliary scintigraphy -- Recurrent -- Reflux cholangitis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.12.010
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Reflux cholangitis is a common complication of Roux-en-Y choledochojejunostomy. The patient had recurrent postoperative reflux cholangitis. There was no stenosis or calculus in choledochojejunostomy anastomosis. Hepatobiliary scintigraphy detected that the blind loop caused the cholangitis. Hepatobiliary scintigraphy could be adjunct to other examination in diagnosing reflux cholangitis. Hepatobiliary scintigraphy is useful to clarify the mechanism of reflux cholangitis. Abstract: Introduction: Reflux cholangitis is a frequent complication of Roux-en-Y choledochojejunostomy. Presentation of case: A 68-year-old male underwent left lobectomy of the liver, bile duct resection and choledochojejunostomy for intrahepatic cholangiocarcinoma located in Segment 2 of the liver, 40 mm in diameter with a lymph node metastasis 5 years ago. He had frequent recurrences of postoperative reflux cholangitis and hepatic abscesses and was treated with antibiotics each time. Postoperative adjuvant chemotherapy was scheduled, but due to recurrent cholangitis it was difficult. Although double balloon endoscopy for endoscopic retrograde cholangiography was performed, no stenosis was found in the choledochojejunostomy anastomosis, and no defect suspected of calculus and stenosis were found by contrast. Antibiotics had to be administered for a long time because it recurred when antibiotics were discontinued. This time, a tumor 2.0 cm in diameter was detected in segment 7 of the liver on follow – up computed tomography. The preoperative diagnosis was recurrent Intrahepatic cholangiocarcinoma. Hepatobiliary scintigraphy was carried out in preparation for concomitant treatment of his reflux cholangitis. Retention in the blind loop of the choledochojejunostomy was retarded, and the excretion was delayed. Therefore, hepatectomy and resection of the blind loop were performed. We confirmed improvement of stasis in the blind loop on postoperative hepatobiliary scintigraphy. The postoperative course was uneventful, and antibiotics were not required. Discussion: Hepatobiliary scintigraphy may be able to clarify the mechanism underlying reflux cholangitis. Conclusion: Hepatobiliary scintigraphy was useful for the treatment of recurrent reflux cholangitis in this case.