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Enterolith formation in the roux limb hepaticojejunostomy.

W S Tan¹, Alexander Y F Chung, Albert S C Low

¹Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore.

Digestive Diseases and Sciences

|October 3, 2007

Summary

A rare enterolith in the Roux limb of Roux-en-Y hepaticojejunostomy caused recurrent cholangitis. Surgical removal of the enterolith and correction of a bowel kink resolved the issue.

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Area of Science:

Gastroenterology
Surgical Innovation
Biliary System Pathologies

Background:

Roux-en-Y hepaticojejunostomy is a surgical procedure to restore biliary continuity.
Enterolith formation within the Roux limb is an uncommon complication.
Recurrent cholangitis can be a symptom of biliary obstruction or stasis.

Observation:

A case of a patient presenting with recurrent cholangitis was identified.
Preoperative diagnosis was achieved using cholescintigraphy and magnetic resonance imaging.
Intraoperative findings included a large enterolith distal to the biliodigestive anastomosis and a small bowel kink.

Findings:

The enterolith was successfully extracted from the Roux limb.
A concurrent small bowel kink was identified and likely contributed to stasis.

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The study discusses the potential mechanisms of enterolith formation in this specific surgical context.

Implications:

This case highlights the importance of considering enterolithiasis in patients with Roux-en-Y hepaticojejunostomy and recurrent cholangitis.
Early diagnosis and surgical intervention are crucial for managing Roux limb enteroliths.
Understanding the pathogenesis may inform preventative strategies for similar complications.