Hepatic ductoplasty for iatrogenic Bismuth type 2 bile duct stricture: A case report.

INTRODUCTION

Biliary enteric anastomosis is a well-known biliary reconstruction method. Anastomosis stricture is one of the complications of this procedure that occurs in some patients over the long-term. We report a successful case of hepatic ductoplasty combined with hepaticojejunostomy (H-J) for the treatment of iatrogenic Bismuth type 2 stricture.

PRESENTATION OF CASE

The patient was a 68-year-woman who had undergone choledochojejunostomy (C-J) 6 years earlier due to bile duct injury after laparoscopic cholecystectomy for cholelithiasis. She complained of recurrent chills and upper back pain. Cholangiography and computed tomography revealed a C-J anastomotic stricture with hepatolithiasis. The diagnosis was reflux cholangitis with hepatolithiasis due to C-J stricture and a fistula between the reconstructed jejunal limb and duodenum. Exploration was performed, and she underwent hepatic ductoplasty with H-J and hepaticolithotripsy. Surgery was performed uneventfully and the patient has remained well subsequently.

DISCUSSION AND CONCLUSION

We propose hepatic ductoplasty as a useful technique for the treatment of selected patients with a C-J stricture or narrow hepatic duct.