Hepatolithiasis followed by recurrent cholangitis as a consequence of inadequate hepaticojejunostomy for common bile duct injury

Abstract

Introduction. Hepatolithiasis (HL) is defined as gallstones present in bile ducts above the common bile duct confluence, regardless of the coexistence of gallstones in other parts of the biliary tract. HL is common among patients with recurrent pyogenic cholangitis. Chronic infection can lead to the development of malignancy. Case outline. A 65-year-old woman presented with intermittent fever, jaundice, abdominal pain, and nausea. Eighteen years previously, the patient had an open cholecystectomy due to acute cholecystitis. During the early post-operative days, the patient developed icterus. Intrahepatic biliary ductal dilatation was confirmed by abdominal ultrasound. Due to suspicion of iatrogenic common bile duct injury, the patient underwent a second operation, during which the said injury was confirmed. ?Non-Roux-en-Y? hepaticojejunostomy (HJ) was performed as a problem-resolving procedure. Despite the performed biliary bypass, the patient continued to have episodes of recurrent cholangitis over the 18 years. Given the patient?s recurrent symptoms and results of MRI consistent with HL, surgical treatment was indicated. A left hepatectomy was performed, with Roux-en-Y HJ biliary reconstruction. The post-operative course was uneventful, after which the patient has been symptom-free. Conclusion. The main purpose of treating HL is to eliminate infection which leads to recurrent cholangitis and subsequent hepatic fibrosis. Adequate solution of HL decreases the need for repeated interventions and prevents progression of the disease to cholangiocarcinoma.