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Cholangiojejunal fistula caused by bile duct stricture after intraoperative injury to the common hepatic artery
Author(s) -
Kishi Yoji,
Kajiwara Shuji,
Seta Shinsuke,
Hoshi Shigenori,
Hasegawa Shunji,
Hayashi Yoichi,
Sasaki Katsumi
Publication year - 2002
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340200015
Subject(s) - medicine , anastomosis , fistula , surgery , common hepatic duct , bile duct , laparotomy , common hepatic artery , asymptomatic , perioperative , exploratory laparotomy , angiography , artery , radiology
A 68‐year‐old man, admitted for the treatment of recurrent cholangitis after a pancreatoduodenectomy (PD) performed 3 years previously was diagnosed as having multiple hepaticolithiasis. On laparotomy, the hepatic artery was not recognized. The anastomosed common hepatic duct was obstructed, and a fistula had been formed between the right hepatic duct and the Roux limb of the jejunum. Lithotripsy was performed from this fistula and it was reanastomosed. Angiography was performed postoperatively and it revealed common hepatic artery injury, most likely to have occurred during the previous PD. The patient's postoperative course was uneventful and he has been asymptomatic for 8 months after the operation, indicating that reanastomosis of the fistula can be an effective method. The stricture of the anastomosis was suspected to be mainly due to cholangial ischemia, because no episode of anastomotic leak or retrograde biliary infection had occurred during the PD perioperative period. There are several reports of late stricture of anastomosis 5 or more years after cholangiojejunostomy. This patient, therefore, requires further long‐term follow up.