Tueme-Izaguirre J, Alvarez-Barragán AF, Martínez-Corral ME, Quintero-Estrada EJ

Language: Spanish
References: 15
Page: 25-29
PDF size: 333.30 Kb.

ABSTRACT

Introduction: in patients undergoing gastric bypass there is an incidence of 20-50% of cholelithiasis and 10% of choledocholithiasis. The management of choledocholithiasis in these patients is a challenge since conventional endoscopic retrograde cholangiopancreatography (ERCP) cannot be used due to the modified anatomy. There are several management options, among which is laparoscopic-assisted endoscopic transgastric ERCP (AL-ERCP). Case presentation: a 51-year-old female patient with a history of cholecystectomy and gastric bypass of one anastomosis who attended the emergency room due to intense pain in the epigastrium, transflictive type, nausea, vomiting, jaundice and choluria. Her laboratories upon admission showed BT 3,640 mg/dL, BD 3,290 mg/dL, TGP 592 U/L, TGO 821 U/L, FA 486 U/L, DHL 647 U/L, amylase 12 U/L, lipase 7 U/L. Cholangio-magnetic resonance imaging was performed, and it reported dilation of the common bile duct of up to 12 mm with a rounded hypointense area adjacent to the sphincter of Oddi, so ERCP-AL was performed. Conclusion: ERCP-AL was an effective treatment without complications in this patient, with hospital discharge. Furthermore, its use allows endoscopic treatment and cholecystectomy to be performed during the same intervention in those patients who require it.

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