Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy: A case report

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Abstract

Rationale:

Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood.

Patient concerns:

A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016.

Diagnoses:

Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD).

Interventions:

During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate.

Outcomes:

After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse.

Lessons:

This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as “pancreatogenic choledocholithiasis,” and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause.

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