Utility of hepatobiliary scintigraphy for recurrent reflux cholangitis following choledochojejunostomy: A case report
| Autor: | Seiichi Shimizu, Tsuyoshi Kobayashi, Michinori Hamaoka, Masateru Yamamoto, Hiroyuki Tahara, Shintaro Kuroda, Kentaro Ide, Masahiro Ohira, Hideki Ohdan |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030230 surgery Anastomosis Scintigraphy Article 03 medical and health sciences 0302 clinical medicine Blind loop medicine Intrahepatic Cholangiocarcinoma Choledochojejunostomy ICC intrahepatic cholangiocarcinoma medicine.diagnostic_test Bile duct business.industry Hepatobiliary scintigraphy digestive oral and skin physiology Reflux Recurrent Intrahepatic Cholangiocarcinoma medicine.disease digestive system diseases CT computed tomography Surgery Stenosis medicine.anatomical_structure S7 segment 7 Reflux cholangitis 030211 gastroenterology & hepatology Hepatectomy Recurrent business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Reflux cholangitis is a common complication of Roux-en-Y choledochojejunostomy. • The patient had recurrent postoperative reflux cholangitis. • There was no stenosis or calculus in choledochojejunostomy anastomosis. • Hepatobiliary scintigraphy detected that the blind loop caused the cholangitis. • Hepatobiliary scintigraphy could be adjunct to other examination in diagnosing reflux cholangitis. • Hepatobiliary scintigraphy is useful to clarify the mechanism of reflux cholangitis. Introduction Reflux cholangitis is a frequent complication of Roux-en-Y choledochojejunostomy. Presentation of case A 68-year-old male underwent left lobectomy of the liver, bile duct resection and choledochojejunostomy for intrahepatic cholangiocarcinoma located in Segment 2 of the liver, 40 mm in diameter with a lymph node metastasis 5 years ago. He had frequent recurrences of postoperative reflux cholangitis and hepatic abscesses and was treated with antibiotics each time. Postoperative adjuvant chemotherapy was scheduled, but due to recurrent cholangitis it was difficult. Although double balloon endoscopy for endoscopic retrograde cholangiography was performed, no stenosis was found in the choledochojejunostomy anastomosis, and no defect suspected of calculus and stenosis were found by contrast. Antibiotics had to be administered for a long time because it recurred when antibiotics were discontinued. This time, a tumor 2.0 cm in diameter was detected in segment 7 of the liver on follow – up computed tomography. The preoperative diagnosis was recurrent Intrahepatic cholangiocarcinoma. Hepatobiliary scintigraphy was carried out in preparation for concomitant treatment of his reflux cholangitis. Retention in the blind loop of the choledochojejunostomy was retarded, and the excretion was delayed. Therefore, hepatectomy and resection of the blind loop were performed. We confirmed improvement of stasis in the blind loop on postoperative hepatobiliary scintigraphy. The postoperative course was uneventful, and antibiotics were not required. Discussion Hepatobiliary scintigraphy may be able to clarify the mechanism underlying reflux cholangitis. Conclusion Hepatobiliary scintigraphy was useful for the treatment of recurrent reflux cholangitis in this case. |
| Databáze: | OpenAIRE |
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