Biliary Bezoar: the sump syndrome and choledochoenterostomy

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Choledochoenterostomy for bile duct stones can lead to sump syndrome.
• Stomal narrowing causes bile duct stasis, debris accumulation, and obstruction.

Observation:

• Sump syndrome presents with pain, cholestasis, and pancreatitis.
• Endoscopic retrograde cholangiopancreatography (ERCP) is a common diagnostic tool.
• A novel case involved stomal adequacy but obstruction by foreign material.

Findings:

• Peroral choledochoscopy diagnosed sump syndrome in a case of stomal obstruction by debris.
• This technique visualizes the bile duct directly for accurate diagnosis.

Implications:

• Peroral choledochoscopy provides a new diagnostic approach for sump syndrome.
• Management involves endoscopic sphincterotomy or surgical revision.
• Preventive surgical strategies can mitigate sump syndrome occurrence.