Pérez PY, Romero DFN, Rosales SAA, Farah OS, Martínez RJC

Language: Spanish
References: 9
Page: 119-124
PDF size: 234.02 Kb.

ABSTRACT

Introduction: Choledocholithiasis is the presence of stones in the common bile duct, and its current treatment requires the participation of a multidisciplinary team. Patients with the reconstruction of the digestive tract, develope cholelithiasis in 46% and 9.69% choledocholithiasis. The current increase in number of cases with bilio-digestive shunts or gastrointestinal shunts with modifications in the anatomy of the digestive tract, makes it difficult to access the bile duct in the presence of choledocholithiasis or concomitant lithiasis of the biliary tract, mainly due to the length of the bilio-enteric loop and the lack of specialized endoscopic devices for cases like these. We present the case of a patient with a modified anatomy of the digestive tract due to previous bilio-enteric shunt and the presence of biliary tract stones and anastomotic stenosis, resolved by endoscopic retrograde cholangiography assisted by laparoscopic enterotomy. Case presentation: A 60-year-old male with a history of a bilio-digestive shunt with a hepatico-jejunal anastomosis in Roux-en-Y, currently with obstructive jaundice secondary to gallstones of the biliary tract with cholangitis. Endoscopic retrograde cholangiography was performed with a conventional endoscope without success because it did not reach the site of the bilio-digestive anastomosis; it was decided to perform an endoscopic retrograde cholangiography assisted by laparoscopic enterotomy, dilatation of the bilio-enteric stenotic site with the use of a balloon and stone extraction, corroborating the result under endoscopic vision. His evolution was favorable without complications, with a short postoperative hospital stay. Conclusions: The increase in cases of surgical modification of the bilio-digestive anatomy favors the presence of gallstones in the biliary tract; it also complicates its endoscopic resolution by the conventional route. Endoscopic retrograde cholangiography assisted by laparoscopic enterotomy is a feasible and viable alternative to the resolution of this problem by working in a synchronous - cooperative way between the surgical and endoscopic groups.

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