title: Cholangiojejunal fistula caused by bile duct stricture after intraoperative injury to the common hepatic artery.
abstract: A 68-year-old man, admitted for the treatment of recurrent cholangitis after a pancreatoduodenectomy (PD) performed 3 years previously was diagnosed as having multiple hepaticolithiasis. On laparotomy, the hepatic artery was not recognized. The anastomosed common hepatic duct was obstructed, and a fistula had been formed between the right hepatic duct and the Roux limb of the jejunum. Lithotripsy was performed from this fistula and it was reanastomosed. Angiography was performed postoperatively and it revealed common hepatic artery injury, most likely to have occurred during the previous PD. The patient's postoperative course was uneventful and he has been asymptomatic for 8 months after the operation, indicating that reanastomosis of the fistula can be an effective method. The stricture of the anastomosis was suspected to be mainly due to cholangial ischemia, because no episode of anastomotic leak or retrograde biliary infection had occurred during the PD perioperative period. There are several reports of late stricture of anastomosis 5 or more years after cholangiojejunostomy. This patient, therefore, requires further long-term follow up.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Police Hospital, 2-10-41 Fujimi, Chiyoda-ku, Tokyo 102-8161, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.forename: Shuji
authors.initials: S
authors.lastname: Kajiwara
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Seta
authors.forename: Shigenori
authors.initials: S
authors.lastname: Hoshi
authors.forename: Shunji
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Katsumi
authors.initials: K
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015901:Angiography, Digital Subtraction; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002758:Cholangiography; D002769:Cholelithiasis / Q000209:etiology / Q000628:therapy; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology*; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007431:Intraoperative Complications; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D007579:Jejunal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008096:Lithotripsy; D008297:Male; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*