2017 Volume 31 Issue 2 Pages 265-270
A 56-year-old man who suffered from epileptic psychosis since childhood underwent hepaticojejunostomy (HJ) Roux-en-Y (RY) reconstruction for bile duct injuries (BDI) during laparoscopic cholecystectomy for cholecystolithiasis. Thereafter, he experienced recurrent cholangitis and was referred to our department for persistent biliary and ileus symptoms. Magnetic resonance cholangiopancreatography in the previous hospital revealed a possible HJ anastomotic stenosis. However, drip infusion cholangiographic-CT (DIC-CT) and percutaneous transhepatic cholangiography showed stasis of the contrast media within the dilatation of the retrocolic RY limb. Thus, open laparotomy was performed, and the bending and slackening condition of the hepatic RY limb was remodeled by dissection. His post-surgical course was uneventful, without cholangitis or ileus. Thus, we experienced a rare case of severe recurrent cholangitis after HJ for post-cholecystectomy BDI caused by improper technical construction without biliary stricture. A multidisciplinary approach including jejunography of the RY limb and cholangiography could be required for good long-term results in this application. DIC-CT was useful for evaluation of the biliary tracts and the RY limb.
