Jiang Yuan-Hui, Zhang An-Hong, Zhou Shao-Jun
aDepartment of General Surgery, Qilu Hospital of Shandong University, Jinan bDepartment of General Surgery, Qilu Hospital of Shandong University, Qingdao, China.
Medicine (Baltimore). 2017 Nov;96(46):e8789. doi: 10.1097/MD.0000000000008789.
Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood.
A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016.
Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD).
During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate.
After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse.
This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as "pancreatogenic choledocholithiasis," and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause.
Roux-en-Y肝空肠吻合术（RYHJ）后胆总管（CBD）残端发生胆总管结石极为罕见，其病理生理机制尚不清楚。
一名79岁女性于2016年11月因上腹部疼痛并向后背部放射入院。
腹部计算机断层扫描（CT）和磁共振胰胆管造影（MRCP）显示CBD残端有充盈缺损、慢性胰腺炎以及CBD残端和主胰管（MPD）扩张。
在内镜逆行胰胆管造影（ERCP）过程中，通过一条变异胰管轻松地从MPD插管至CBD，然后从CBD残端取出白色碎石。元素分析和红外分光光度法表明结石的主要成分是碳酸钙。
治疗性ERCP后，患者症状消失，9个月的随访显示无残留结石或结石复发。
此前从未报道过RYHJ后CBD残端出现这种类型的胆总管结石。我们将其命名为“胰源性胆总管结石”，变异胰管引起的胰胆反流可能是主要原因。
