Cholecystojejunostomy

Cholecystojejunostomy is generally not recommended as a biliary decompression procedure for benign disease because the cystic duct frequently causes a relative obstruction. The gallbladder is often used for biliary bypass in malignant disease if the insertion of the cystic duct is sufficiently proximal to the obstructing tumor. The use of stents for biliary drainage has obviated the need for this procedure in many circumstances. After cholecystojejunostomy, barium should fill the biliary tree during upper GI examination. The gallbladder can be readily identified as distinct from small bowel by its characteristic mucosal pattern (Fig. 4.41).

Figure 4.41. Cholecystojejunostomy. Supine view from a small-bowel series demonstrates both contrast medium in the gallbladder and biliary tree filling via a cholecystojejunal anastomosis.

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