A case of magnetic compression anastomosis between the common bile duct and the duodenum after distal gastrectomy with Roux-Y reconstruction and cholecystectomy

Abstract

An 83-year-old man was admitted to our hospital with jaundice. At the age of 79, he had undergone distal gastrectomy with Roux-Y reconstruction and cholecystectomy due to early gastric cancer and gall bladder carcinoma. CT and MRI revealed severe dilatation from the common bile duct (CBD) to the intra-hepatic bile duct. Blood tests showed high serum levels of bilirubin and CA19-9. Cytology of the bile juice was Class V. Percutaneous transhepatic bile duct drainage was performed. Curative surgical resection was not indicated due to his age and general condition. Neither percutaneous nor endscopical fistulization were successful. Finally magnetic compression anastomosis was performed. Under general anesthesia, the first magnet was placed in the CBD through a cutaneous fistula. The second one was placed in the duodenum through the jejunum. The two magnets attached the walls of the CBD and duodenum. Three weeks after the maneuver, the anastomosis was completed with only a slight fever.