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Common bile duct stump stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy in a child: A
Jian-Feng Li1, Min-Jian Xie2, Jin-Xiu Wei1
1Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China.
Insights
A child with pancreaticobiliary maljunction (PBM) experienced recurrent pancreatitis after surgery. Endoscopic retrograde cholangiopancreatography successfully treated residual bile duct stones and pancreatitis post-PBM surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Pancreaticobiliary maljunction (PBM) is a rare congenital anomaly.
- PBM can lead to pancreaticobiliary reflux, causing conditions like acute pancreatitis, particularly in children.
- Roux-en-Y choledochojejunostomy is a standard surgical treatment for PBM, but carries potential complications.
Observation:
- A 12-year-old female presented with recurrent acute pancreatitis, requiring multiple hospitalizations.
- Following laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy for PBM, the patient continued to experience over 10 episodes of acute pancreatitis within a year.
- Further investigations revealed residual bile duct stones as the cause of persistent pancreatitis.
Findings:
- The case highlights residual bile duct stones as a complication following Roux-en-Y choledochojejunostomy in a pediatric patient with PBM.
- Recurrent acute pancreatitis persisted despite initial surgical intervention for PBM.
Implications:
- This case underscores the importance of considering and diagnosing residual bile duct stones in patients with persistent pancreatitis after PBM surgery.
- Endoscopic retrograde cholangiopancreatography (ERCP) offers an effective minimally invasive treatment for such complications.
- Successful ERCP treatment in this case suggests it as a viable therapeutic option for post-surgical bile duct stones in pediatric PBM patients.
Background:
Pancreaticobiliary maljunction (PBM) is a rare congenital abnormality in pancreaticobiliary duct development. PBM is commonly found in children, and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux. Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM, but there are several associated complications that may occur after this operation.
Case Summary:
The patient, a 12-year-old female, was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis. In 2022, she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital. In the first year after surgery, the patient had more than 10 recurrent acute pancreatitis episodes. After undergoing abdominal computed tomography and other examinations, she was diagnosed with "residual bile duct stones and recurrent acute pancreatitis". On January 30, 2024, the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.
Conclusion:
This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM. The patient was cured through endoscopic retrograde cholangiopancreatography.
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