Hirata Ken, Kawamura Daichi, Orita Masahiko
Department of Surgery, Hikari Municipal Hikari General Hospital, Hikarigaoka 6-1, Hikari, Yamaguchi, 743-8561, Japan.
Surg Case Rep. 2021 Feb 25;7(1):58. doi: 10.1186/s40792-021-01142-6.
The presence of a foreign body in the common bile duct (CBD) is a rare phenomenon. Thus, the route and mechanism of its migration remain difficult to fully clarify, especially for cases that occur after gastrectomy with Roux-en-Y reconstruction. Herein, we present a case of a CBD stone that formed around a fish bone as a nidus subsequent to distal gastrectomy with Roux-en-Y reconstruction.
A 70-year-old man was admitted to our hospital due to repeated episodes of epigastralgia. He had undergone distal gastrectomy with Roux-en-Y reconstruction for gastric cancer approximately 10 years prior. Blood tests revealed obstructive jaundice, hepatobiliary dysfunction, and inflammation. Multi-plane reconstructed computed tomography (CT) revealed a CBD stone with a needle-shaped calcification density at the center, oriented along the length of the CBD. Surgery was performed using an upper median laparotomy approach. Lithotomy with choledochotomy was performed to remove one fragile bilirubin stone that had formed around a 3-cm, needle-shaped fish bone. A choledochoduodenal fistula was not detected intraoperatively. A review of the imaging of a prior examination revealed that the formation of the CBD stone around the fish bone was observable on a follow-up CT performed approximately 2 years prior. However, no clinical symptoms associated with the migration of the fish bone to the CBD were reported and the fish bone was not detected at that time.
In this case, transpapillary migration of the fish bone could only be speculated in the absence of an observable fistula, choledochostomy, or any clinical symptoms. Our case is clinically relevant as cholangitis developed after CBD stone formation around the fish bone that acted as a nidus.
胆总管（CBD）内存在异物是一种罕见现象。因此，其迁移途径和机制仍难以完全阐明，尤其是在 Roux-en-Y 重建胃切除术后发生的病例。在此，我们报告一例在 Roux-en-Y 重建胃切除术后，以鱼骨为核心形成胆总管结石的病例。
一名 70 岁男性因反复上腹部疼痛入院。他大约在 10 年前因胃癌接受了 Roux-en-Y 重建胃切除术。血液检查显示梗阻性黄疸、肝胆功能障碍和炎症。多平面重建计算机断层扫描（CT）显示胆总管结石，中心有针状钙化密度，沿胆总管长度方向排列。采用上腹部正中剖腹手术入路进行手术。行胆总管切开取石术，取出一枚围绕 3 厘米针状鱼骨形成的易碎胆红素结石。术中未发现胆总管十二指肠瘘。回顾先前检查的影像学资料发现，大约在 2 年前的随访 CT 上就可观察到鱼骨周围胆总管结石的形成。然而，当时未报告与鱼骨迁移至胆总管相关的临床症状，也未检测到鱼骨。
在本病例中，由于未观察到瘘管、胆总管造口或任何临床症状，只能推测鱼骨经乳头迁移。我们的病例具有临床相关性，因为以鱼骨为核心形成胆总管结石后发生了胆管炎。
