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[Obstructive jaundice after granade splinter injury 49 years ago]
U Gottschalk1, B Weber, R Felfe
1I. Medizinische Klinik, Städtisches Krankenhaus im Friedrichshain Berlin.
Zeitschrift Fur Gastroenterologie
|March 1, 1993
Summary
A man experienced severe abdominal pain and jaundice after stomach surgery due to a bile duct stone. Endoscopic removal was challenging due to inflammation and a splinter within the stone.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Endoscopic Procedures
Background:
- Billroth II gastrojejunostomy is a surgical procedure for stomach resection.
- Obstructive jaundice and cholangitis can be complications following gastric surgery.
- Common bile duct stones (choledocholithiasis) are a frequent cause of biliary obstruction.
Observation:
- A 69-year-old male presented with severe right upper quadrant abdominal pain and obstructive jaundice.
- The patient had a history of Billroth II gastric resection.
- Imaging revealed a common bile duct stone containing a central shell splinter.
Findings:
- The patient suffered from purulent cholangitis with distal common bile duct stenosis.
- Endoscopic retrograde cholangiopancreatography (ERCP) was performed for stone removal.
- Multiple ERCP attempts were required for successful stone extraction due to the stone's nature and ductal inflammation.
Implications:
- This case highlights the complexity of managing choledocholithiasis in post-gastric surgery patients.
- Endoscopic management of bile duct stones can be challenging in the presence of anatomical alterations and inflammation.
- Successful endoscopic stone removal, even after repeated attempts, is crucial for resolving cholangitis and jaundice.