Choledocholithiasis Treated by Percutaneous Transhepatic Gallbladder Drainage during Laparoscopic Cholecystectomy in a Patient who had Previously Undergone a Roux-en Y Gastric Reconstruction

Abstract

An 86-year-old man who had undergone laparoscopic distal gastrectomy with Roux-en Y reconstruction for gastric cancer 6 years earlier presented with acute obstructive suppurative cholangitis. Abdominal CT revealed enlargement of the gallbladder. Percutaneous transhepatic gallbladder drainage (PTGBD) was instituted on the first hospital day. Because of the Roux-en Y reconstruction, endoscopic treatment was not possible. We attempted to remove the choledocholith via the PTGBD tube on the 13th hospital day, but were unable to cannulate the cystic duct. The choledocholith was removed by straightening the cystic duct during laparoscopic cholecyctectomy on the 25th hospital day.