Successful management of intrahepatic bile duct stones complicating choledochojejunostomy stenosis, using a covered metallic stent

Abstract

A 77-year-old woman underwent pancreaticoduodenectomy and Child's reconstruction for advanced duodenal cancer in 2012. During the 18 months following surgery, the patient was admitted six times with repeated cholangitis. Computed tomography showed intrahepatic bile duct dilation due to stones in the left hepatic duct. Using a colonoscope and double-balloon scope, we were not able to detect the choledochojejunostomy. After performing percutaneous biliary drainage, we successfully used the rendezvous method for cannulation of the bile duct. We attempted to extend the stenosis of the choledochojejunostomy using a biliary balloon dilatation catheter ; however, we were not able to achieve sufficient dilatation through the severe stenosis. Therefore, we deployed a covered metallic stent (CMS) , to dilate the stenosis of the choledochojejunostomy. After achieving sufficient dilatation of the stenosis with the CMS extension, the CMS was removed. This procedure sufficiently dilated the severe stenosis of the choledochojejunostomy to allow for safe removal of the intrahepatic bile duct stones. Cholangitis did not recur for six months after the procedure.