Drb

Figure 4.37. Sump syndrome after choledochoduodenostomy. Oblique film from a double-contrast upper GI series shows filling of the biliary tree via a choledochoduodenostomy with filling defects in the common bile duct due to debris. Debris and/or lithogenic bile in the distal stagnant portion of the CBD may result in intermittent obstruction of the choledochoduodenal anastomosis, resulting in pain, cholestasis, and/or pancreatitis.

Figure 4.37. Sump syndrome after choledochoduodenostomy. Oblique film from a double-contrast upper GI series shows filling of the biliary tree via a choledochoduodenostomy with filling defects in the common bile duct due to debris. Debris and/or lithogenic bile in the distal stagnant portion of the CBD may result in intermittent obstruction of the choledochoduodenal anastomosis, resulting in pain, cholestasis, and/or pancreatitis.

produces pain, cholestasis, and/or pancreatitis (Fig. 4.37). In some cases, the stoma remains adequate, but the debris itself produces symptoms. Treatment is often successful with antibiotics alone. Endoscopic sphincterectomy and bile duct clearance with a balloon catheter or basket may be necessary [60].

Stricture at the anastomotic site may occur after choledochoduo-denostomy. The stoma usually decreases in diameter following surgery, but it may become strictured or occluded. Endoscopic percutaneous balloon dilatation may be used as an effective therapy, although reoperation may be required.

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