What is it about?
A 25-year-old woman had undergone extrahepatic excision of a congenital choledochal cyst and Roux-en-Y hepaticojejunostomy. Twenty-five years later, she was referred to our hospital for treatment of intrahepatic stones causing recurrent cholangitis. MRCP revealed dilated lateral hepatic ducts filled with stones. At the hospital she had visited previously, cholangiography of the right hepatic ducts was successful using double-balloon enteroscopy, but both cholangiography of the left hepatic duct and guidewire insertion into it failed, perhaps because the duct was packed with stones. How to treat this case?
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Why is it important?
This case report shows the challenges encountered during endoscopic treatment of intrahepatic stones after choledochal cyst excision and how to deal with them, how to reach the hepaticojejunostomy with the cholangioscope, how to pass contrast medium through packed stones, and how to deal with stones upstream of a stenosis.
Perspectives
I believe that overcoming difficult situations through ingenuity and contributing to the health of patients is the real pleasure of endoscopist.
Yukihiro Shirota
Saiseikai Kanazawa Hospital
Read the Original
This page is a summary of: Temporary placement of a fully covered self-expandable metal stent with electrohydraulic lithotripsy under direct cholangioscopic control for intrahepatic stones upstream of a stenosis after choledochal cyst excision, VideoGIE, July 2020, Elsevier,
DOI: 10.1016/j.vgie.2020.03.012.
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