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2019, Number 1

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Rev Mex Cir Endoscop 2019; 20 (1)

Bile duct exploration + laparoscopic choledocoduodenoanastomosis as management of primary choledocholithiasis of large, difficult-to-manage elements

Pérez PY, Santana PCA, Santiago MJP, Pérez LÁ

Language: Spanish
References: 14
Page: 31-35
PDF size: 247.50 Kb.


ABSTRACT

Biliary lithiasis is a condition that according to some studies affects 20% of the world's population. And in 20% of cases of gallstones is accompanied by stones in the main bile duct. Clinical case: The case of a 58-year-old patient with a history of type 2 diabetes mellitus and systemic arterial hypertension as well as laparoscopic cholecystectomy eight years earlier, who had a clinical picture characterized by icteric syndrome and abdominal pain, being diagnosed by ultrasound, tomography and laboratories as moderate cholangitis and primary choledocholithiasis of large elements, first managed with endoscopic retrograde cholangiopancreatography (ERCP) with failed result by lith impaction of large elements. Due to the persistence of cholestatic pattern and high risk of severe cholangitis, laparoscopic exploration of the bile duct and choledocoduodenoanastomosis hepatoenteric derivation are performed without immediate complications. In the postoperative evolution, it can be tolerated orally after three days without immediate or mediate complications. Conclusion: Primary choledocholithiasis or secondary choledocholithiasis that is difficult to manage due to its large elements is a pathology that may carry a risk of ascending infection of the bile duct (cholangitis) and pericolangiotic abscesses. Diagnosis should be performed according to the standards established by the American and European Gastrointestinal Endoscopy Guidelines for Choledocholithiasis. Endoscopic management should be the first guideline for treatment without leaving aside the possibility of surgical resolution, laparoscopic management is a feasible option as long as it is safe for the patient and has the experience and resources for its implementation.


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