Intrahepatic bile duct stones occurred during the long-term follow-up period after the pancreatoduodenectomy for a case with an advanced stage gallbladder carcinoma

Abstract

A case with multiple stones in the intrahepatic bile duct 5 years after pancreatoduodenectomy is presented. A 67-year-old female was admitted to our hospital because of the symptoms compatible with cholangitis. The patient was diagnosed as stage IVa gallbladder carcinoma 5 years before and underwent pancreatoduodenectomy associated with the partial hepatectomy and was reconstructed with a so called “Imanaga I” procedure. No findings indicating the recurrence of carcinoma had been noted during the follow-up period except a sustained and modest increase in plasma CA 19-9 level. Magnetic resonance cholangiopancreatography revealed a dilatation of intrahepatic bile duct and multiple biliary stones. Percutaneous transhepatic biliary drainage was performed and the stones were then removed under cholangioscopy. The cholangioscopy revealed a stenotic choledochojejunostomy of which size was 3 mm in diameter. The dilatation procedure using a balloon catheter was repeatedly performed to facilitate bile flow. No cancer cells were detected either from biopsy specimen obtained from the anastomotic site or bile fluid. A 24-Fr Nelaton catheter was placed in the stenotic site as a stent for 6 months and was then removed. No findings indicating anastomotic stenosis has been noted for 30 months after the removal of the catheter.