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Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report.

Lee HG, Hwang S, Joo YH, Cho YJ, Choi K - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Since the clinical manifestation was improved, we decided to observe her closely.She recovered and returned to normal life after 10 days of initiation of clinical manifestations.We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

No MeSH data available.


Related in: MedlinePlus

Initial computed tomography finding showing a radiopaque stone (arrow) at the upstream afferent loop bowel (A) with concentric bowel wall thickening and dilatation of the segmental jejunal loop (B).
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Figure 1: Initial computed tomography finding showing a radiopaque stone (arrow) at the upstream afferent loop bowel (A) with concentric bowel wall thickening and dilatation of the segmental jejunal loop (B).

Mentions: Abdomen-pelvis CT scan showed that there was a 1.7 cm-wide and 2.5 cm-long radiopaque stone at approximately 15 cm below the level of hepaticojejunostomy site with upstream afferent loop bowel dilatation and concentric bowel wall thickening of the segmental jejunal loop (Fig. 1). The intrahepatic ducts were also dilated with inhomogeneous enhancement of the liver parenchyma. Thus the primary diagnosis was gallstone ileus causing afferent loop syndrome and enteritis. Thereafter, she was transferred to our institution for further management.


Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report.

Lee HG, Hwang S, Joo YH, Cho YJ, Choi K - Korean J Hepatobiliary Pancreat Surg (2015)

Initial computed tomography finding showing a radiopaque stone (arrow) at the upstream afferent loop bowel (A) with concentric bowel wall thickening and dilatation of the segmental jejunal loop (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494082&req=5

Figure 1: Initial computed tomography finding showing a radiopaque stone (arrow) at the upstream afferent loop bowel (A) with concentric bowel wall thickening and dilatation of the segmental jejunal loop (B).
Mentions: Abdomen-pelvis CT scan showed that there was a 1.7 cm-wide and 2.5 cm-long radiopaque stone at approximately 15 cm below the level of hepaticojejunostomy site with upstream afferent loop bowel dilatation and concentric bowel wall thickening of the segmental jejunal loop (Fig. 1). The intrahepatic ducts were also dilated with inhomogeneous enhancement of the liver parenchyma. Thus the primary diagnosis was gallstone ileus causing afferent loop syndrome and enteritis. Thereafter, she was transferred to our institution for further management.

Bottom Line: Since the clinical manifestation was improved, we decided to observe her closely.She recovered and returned to normal life after 10 days of initiation of clinical manifestations.We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

No MeSH data available.


Related in: MedlinePlus