title: Intrahepatic cholangiojejunostomy (Longmire procedure) for recurrent bilioenteric anastomotic stricture with hepatolithiasis.
abstract: Interventional procedure via percutaneous transhepatic route is often performed, as an initial treatment, in patients with benign bilioenteric anastomotic stricture. However, surgical management is required in most cases in which radiological intervention is unsuccessful. In this report, we describe a case of a 67-year-old woman with recurrent bilioenteric anastomotic stricture, accompanying bilateral hepatolitiasis after several times of transhepatic interventions. The patient underwent intrahepatic cholangiojejunostomy (Longmire procedure) and cholangioscopic lithotomy after resection of an atrophic left lateral segment resulting from hepatolithiasis. Although the damaged hilar bile duct had to be isolated and divided from the corresponding vasculature for re-anastomosis, it was quite impossible due to severe inflammatory change at the hepatic hilus. We, therefore, anastomosed the intact biliary stump on the cut surface of the left lateral segment to the jejunal loop with a stent tube. The patient's postoperative course was uneventful and she exhibited no evidence of cholangitis during follow-up period of 1 year after surgery. At present, the indications for intrahepatic cholangiojejunostomy for biliary obstruction, are quite limited, but biliary surgeons should keep this procedure in mind at the time of biliary reconstruction for benign proximal bile duct stricture, particularly in cases of multiply operated hilum.
authors.affiliation: Department of General Surgery, Chiba University, Chiba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Katunori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Noboru
authors.initials: N
authors.lastname: Mitsuhashi
authors.forename: Dan
authors.initials: D
authors.lastname: Takeuchi
authors.forename: Tukasa
authors.initials: T
authors.lastname: Takayashiki
authors.forename: Kosuke
authors.initials: K
authors.lastname: Suda
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002780:Cholestasis, Intrahepatic / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D012008:Recurrence