Abstract
A case of intrahepatic calculi that developed after operation for congenital choledochectasis is reported. A 22-year-old woman visited the hospital because of frequent episodes of fever since February 1989, and was admitted under a diagnosis of intrahepatic stones confirmed by US. There was a history of congenital choledochectasis that was surgically treated with cholecystectomy, choledochectomy, and choledochojejunostomy at other hospital in 1985. On admission, no association with cancer was found in preoperative close examination. The anterior wall of the jejunum near the anastomosis was incised, lithotripsy was done as much as possible, and tube jejunostomy was carried out near the jejunal bline loop for postoperative trans-jejunal lithotripsy. Cholangioscopic lithotripsy and dilation of bile duct stenosis using a balloon were made frequently after operation through this jejunal fistula, and complete removal of stones was confirmed. Moreover, an expandable metallic stent was placed in the bile duct to prevent re-stenosis, and the patient was discharged on confirmation of the absence of stenosis by cholangioscopy and cholangiography. Anastomotic stenosis and remnant bile duct stenosis are primary causes of lithogenesis after operation for ectasis, and caution is needed in the selection of the site and method for the initial anastomosis.
