Related Experiment Video
Updated: Jul 19, 2026
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
Obstructive jaundice caused by biliary stone formation around the stent after liver transplantation
Naoki Kawagishi1, Chikashi Matsuo, Ikuo Takeda
1Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan. kawan@mail.tains.tohoku.ac.jp
Insights
A retained stent in a Roux-en-Y hepaticojejunostomy stump led to obstructive jaundice from a large biliary stone in a liver transplant patient. This highlights potential complications from surgical materials in biliary reconstruction.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Gastroenterology
Background:
- Biliary atresia is a severe condition requiring early intervention, often involving hepaticojejunostomy.
- Liver transplantation (LT) is a life-saving procedure for end-stage liver disease, including biliary atresia.
- Roux-en-Y hepaticojejunostomy is a common surgical technique used in biliary reconstruction and after LT.
Observation:
- A 13-year-old male, post-liver transplant and hepaticojejunostomy, presented with obstructive jaundice and liver dysfunction.
- Imaging revealed a large, rugby ball-shaped biliary stone within a dilated jejunal loop stump of the hepaticojejunostomy.
- Surgical exploration confirmed the stone's presence and identified a previously placed hepaticojejunostomy stent within the calculus.
Findings:
- The biliary stone was formed around a retained surgical stent within the stump of the Roux-en-Y hepaticojejunostomy.
- Stagnated bile and anatomical variations in the jejunal loop contributed to stone formation.
- The retained stent acted as a nidus for the biliary calculus, causing obstructive jaundice.
Implications:
- This case underscores the importance of complete stent removal after hepaticojejunostomy to prevent long-term complications.
- Retained surgical materials can lead to significant morbidity, including biliary obstruction and stone formation.
- Careful surgical technique and follow-up are crucial in managing patients with complex biliary reconstructions and liver transplants.
Abstract:
We report an unusual case of obstructive jaundice caused by a biliary stone, which developed in the stump of a Roux-en-Y hepaticojejunostomy after undergoing LT. The patient was a 13-yr-old male. At 74 days after birth, a hepaticojejunostomy (Kasai's procedure) was performed for the treatment of biliary atresia. He underwent a reduced size deceased donor LT in the left subphrenic space twice at the age of one and three years in Australia. Eleven years after his second LT, he developed liver dysfunction and jaundice with a low grade fever. Computed tomography showed a marked jejunal loop enlargement by a rugby ball-shaped stone and the bile duct in the graft was thus dilated. A surgical exploration revealed the jejunal loop to be bent sharply while its stump side was dilated by stagnated bile including a biliary stone. The stone included a stent that had been previously used for the hepaticojejunostomy. This case suggests that a retained stent used for hepaticojejunostomy had thus caused biliary stone formation because of a combination of various conditions in the jejunal loop.
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not related to...
01:25Jaundice
01:20Cholecystitis