2022 Volume 64 Issue 10 Pages 2288-2294
A 69-year-old man who underwent subtotal stomach-conserving pancreatoduodenectomy developed complete obstruction of the anastomosis during the 10th postoperative month. He underwent cholangioscopy using single-balloon enteroscopy (SBE) and percutaneous transhepatic bile duct drainage; however, these procedures were unsuccessful. Therefore, we performed EUS-hepaticogastrostomy for internal fistulization. However, we detected intrahepatic stones, and considering the high risk of cholangitis, we performed release of the anastomotic stenosis from the jejunal aspect using a forward-viewing linear endoscopic ultrasound (FV-EUS). We subsequently performed anastomotic dilation and stone removal using SBE. Anastomotic dilation using FV-EUS in a patient with complete obstruction of a choledochojejunostomy facilitated subsequent stone removal and ongoing maintenance of the anastomosis.
