2022 Volume 36 Issue 2 Pages 166-171
We report a case of repeated needle-shaped intrahepatic stones after pancreaticoduodenectomy. The patient was a man in his 60s. He underwent pancreaticoduodenectomy for intraductal papillary mucinous neoplasm. Two years after the operation, CT revealed a linear hyper-attenuated structure reaching from the left intrahepatic bile duct to the hepaticojejunostomy. Four years after the operation, he developed acute cholangitis and underwent balloon enteroscopy. The aperture of the hepaticojejunostomy was filled with a bundle of black-brown needle-shaped objects with muddy stones. We removed them using grasping forceps. The patient was stable after treatment, but cholangitis developed two years after the endoscopic treatment and CT revealed similar linear hyper-attenuated structures. Enteroscopy was performed and needle-shaped stones were again found in the anastomotic site. We removed them endoscopically. Subsequent CT confirmed the disappearance of the needle-shaped objects; however, they were visualized again one year after second retreatment. The main component of the endoscopically removed objects was bilirubin calcium.
