Abd-El-Hafez Mahmoud K, Roper Monte L, Durkee Kevin, De la Torre Roger A
Menorah Medical Center Department of General Surgery Residency, HCA Midwest Healthcare System, Overland Park, KS 66209, United States.
Department of Bariatric and Metabolic Surgery, HCA Midwest Healthcare System, Overland Park, KS 66209, United States.
J Surg Case Rep. 2025 Jun 6;2025(6):rjaf365. doi: 10.1093/jscr/rjaf365. eCollection 2025 Jun.
We present the unusual case of a 66-year-old female who was found to have ascending cholangitis following hepatobiliary scintigraphy and fatty meal administration, in the setting of isolated cholelithiasis. Given her surgical history of Roux-en-Y gastric bypass, a robotic cholecystectomy with transcystic common bile duct (CBD) exploration was performed. Patient was discharged on post-operative day (POD) 7 with a T-tube following antibiotic completion. Tube study at 1 week confirmed resolution of her CBD outlet obstruction. Acute cholangitis is a concerning outcome following hepatobiliary iminodiacetic acid scan and cholecystokinin (CCK) administration in patients with preexisting cholelithiasis. We do believe that this is a risk that warrants consideration and informed patient discussion when using this imaging modality. We also present an early experience with transcystic common bile duct exploration with balloon dilation. A technique, we believe, will be of benefit for our bariatric patient population when presenting with choledocholithiasis or acute cholangitis.
我们报告了一例不同寻常的病例，一名66岁女性在孤立性胆石症的情况下，经肝胆闪烁显像和脂肪餐给药后出现了上行性胆管炎。鉴于她有 Roux-en-Y 胃旁路手术史，遂进行了机器人胆囊切除术并经胆囊探查胆总管（CBD）。患者在术后第7天完成抗生素治疗后带T管出院。术后1周的胆管造影证实其胆总管出口梗阻已解除。对于已有胆石症的患者，在进行肝胆亚氨基二乙酸扫描和胆囊收缩素（CCK）给药后出现急性胆管炎是一个令人担忧的结果。我们确实认为，在使用这种成像方式时，这是一个值得考虑的风险，并且需要与患者进行充分的沟通。我们还介绍了经胆囊用球囊扩张探查胆总管的早期经验。我们认为，当肥胖症患者出现胆总管结石或急性胆管炎时，这项技术将对他们有益。
