Robbins Gordon, Brilliant Justin, Huang Yuting, Rubin Jonah, Goldberg Eric, Lominadze Zurabi
Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2021 Sep 20;11(5):667-669. doi: 10.1080/20009666.2021.1949794. eCollection 2021.
Sump syndrome - a collection of digested food, debris, stones, bile, and bacteria in a poorly drained, bile duct reservoir - occurs most commonly after a side-to-side choledochoduodenostomy. As choledochoduodenostomies are now less common, sump syndrome is more often characterized as a complication of Roux-en-Y hepaticojejunostomies; however, most cases occur at the hepaticojejunostomy anastomosis. We report a rare case of sump syndrome in the intra-pancreatic remnant common bile duct in a patient with primary sclerosing cholangitis following living donor liver transplant via Roux-en-Y hepaticojejunostomy. Our patient had a history of end-stage liver disease secondary to primary sclerosing cholangitis but presented with recurrent bacteremia and symptoms of acute cholangitis following her transplant. While this complication has not been reported in this population, we know that those with primary sclerosing cholangitis and those undergoing liver transplantation are at very high risk for biliary complications and strictures. Liver transplant is currently our only treatment for primary sclerosing cholangitis, and more than any other group, they are referred for living donor liver transplantation, preferably via Roux-en-Y hepaticojejunostomy. Thus, our patient's clinical scenario is not uncommon and demonstrates a source of serious infection of which providers must be aware.
贮袋综合征——一种在引流不畅的胆管贮袋中积聚消化食物、残渣、结石、胆汁和细菌的病症——最常见于胆总管十二指肠侧侧吻合术后。由于胆总管十二指肠吻合术如今已较少见，贮袋综合征更多地被视为 Roux-en-Y 肝空肠吻合术的一种并发症；然而，大多数病例发生在肝空肠吻合处。我们报告了一例罕见的贮袋综合征病例，该病例发生在一名原发性硬化性胆管炎患者活体肝移植后经 Roux-en-Y 肝空肠吻合术形成的胰内残余胆总管中。我们的患者有原发性硬化性胆管炎继发终末期肝病的病史，但在移植后出现复发性菌血症和急性胆管炎症状。虽然该并发症在这一人群中尚未见报道，但我们知道原发性硬化性胆管炎患者和接受肝移植的患者发生胆道并发症和狭窄的风险非常高。肝移植目前是我们治疗原发性硬化性胆管炎的唯一方法，而且与其他任何群体相比，他们更常接受活体肝移植，最好是通过 Roux-en-Y 肝空肠吻合术。因此，我们患者的临床情况并不罕见，显示出一种严重感染源，医疗人员必须对此有所认识。
