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03 October 2018 : Case report  Japan

Endoscopic Retrograde Cholangiopancreatography (ERCP) with Laparotomic Small-Intestinal Incision Approach for Extraction of a Common Bile Duct (CBD) Stone Following Total Gastrectomy and Roux-en-Y (R-Y) Anastomosis: A Case Report

Unusual setting of medical care

Hiroki Nakamoto1ABCDEF, Makoto Nishikawa1E*, Takahisa Ishikawa1E, Ryouji Yokoyama1E, Akinobu Taketomi2E

DOI: 10.12659/AJCR.911325

Am J Case Rep 2018; 19:1175-1178

Abstract

BACKGROUND: Endoscopic retrograde cholangiopancreatography for common bile duct stone in patients who underwent gastrectomy and Roux-en-Y anastomosis is challenging. We report a case in which we performed endoscopic retrograde cholangiopancreatography through a small-intestinal incision approach for a common bile duct stone, which had developed after total gastrectomy and Roux-en-Y anastomosis.

CASE REPORT: An 86-year-old woman with a history of laparoscopic-assisted total gastrectomy and R-Y anastomosis and incision of the common bile duct and cholecystectomy for common bile duct stone by open surgery 3 years ago presented with abdominal pain. Examination revealed a 10-mm stone in the lower part of common bile duct. We planned a combined endoscopic and open surgical approach. An incision on the Y limb of the Roux-en-Y anastomosis 20 cm from the jejunojejunal anastomosis and insertion of an endoscope through this opening were performed to extract the common bile duct stone. The patient was discharged on postoperative day 22 without complications.

CONCLUSIONS: For a patient with a common bile duct stone, who underwent gastrectomy and Roux-en-Y anastomosis, with firm adhesions at the porta hepatis, combined endoscopy and open surgery using a small-intestinal incision approach can be effective when small-bowel endoscopes are unavailable or the cannulation to Vater’s papilla by them is difficult.

Keywords: Anastomosis, Roux-en-Y, Cholangiopancreatography, Endoscopic Retrograde, Common Bile Duct

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923