EP.FRI.199 Impacted common bile duct stone managed by hepaticoduodenostomy. (28th October 2021) - Weledji, Elroy
Abstract: The management strategy of common bile duct stone will depend on personal experience, equipment availability, time and the availability of other departmental expertise. For a distally impacted common bile duct (CBD) stone in a low resource setting, an open approach will entail either leaving the stone where it is and carry out a choledochoduodenostomy, or removing the stone through a transduodenal sphincteroplasty. The latter has a significant risk of causing an acute pancreatitis. A case report of a hepaticoduodenostomy performed on a 40-year-old black African man for a retained, impacted distal CBD stone in a low resource setting with a good outcome is presented. The impacted CBD stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction. A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal CBD stone especially in the presence of sepsis. A wide side- to-side hepaticoduodenostomy (>3cm d) is a safe and definitive procedure for the decompression of lower CBD obstruction and has good long-term results with infrequent complications including reflux cholangitis, hepatic abscess, stone recurrence, pancreatitis and the 'sump' syndrome. This case demonstrates that a hepaticoduodenostomy is safe and effective in rescuing the adverse sequelae of an impacted distal CBD stone in a low resource setting.