Hirotaka Okamoto, Takahashi Kazunori, Hiroyuki Wakana, Kawashima Kenji, Ichikawa Daisuke, Hideki Fujii
Department of Surgery, Tsuru Municipal Hospital, Japan; Department of Gastrointestinal, Breast & Endocrine Surgery, Faculty of Medicine, University of Yamanashi, Japan.
Department of Surgery, Tsuru Municipal Hospital, Japan; Department of Gastrointestinal, Breast & Endocrine Surgery, Faculty of Medicine, University of Yamanashi, Japan.
Int J Surg Case Rep. 2018;51:161-164. doi: 10.1016/j.ijscr.2018.08.025. Epub 2018 Aug 19.
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.
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.
We propose hepatic ductoplasty as a useful technique for the treatment of selected patients with a C-J stricture or narrow hepatic duct.
胆肠吻合术是一种广为人知的胆道重建方法。吻合口狭窄是该手术的并发症之一，部分患者会在长期随访中出现。我们报告了一例成功采用肝管成形术联合肝管空肠吻合术（H-J）治疗医源性毕氏2型狭窄的病例。
患者为一名68岁女性，6年前因腹腔镜胆囊切除术治疗胆结石后胆管损伤接受了胆总管空肠吻合术（C-J）。她主诉反复寒战和上背部疼痛。胆管造影和计算机断层扫描显示C-J吻合口狭窄合并肝内胆管结石。诊断为因C-J狭窄导致的反流性胆管炎合并肝内胆管结石，以及重建空肠袢与十二指肠之间的瘘。进行了探查，患者接受了肝管成形术联合H-J和肝内胆管结石碎石术。手术顺利完成，患者随后恢复良好。
我们提出肝管成形术是治疗特定C-J狭窄或肝管狭窄患者的一种有效技术。
