Original Article

Cholangitis and Choledocholithiasis after Repair of Duodenal Atresia: A Case Report

Abstract

Cholelithiasis is a rare but known complication of surgery for duodenal atresia. Occurrence of choledocholithiasis as sequelae of duodenoduodenostomy is still rarer. Biliary stasis resulting from compression of common bile duct due to periductal fibrosis may predispose to gallstone formation. We are reporting a case of choledocholithiasis in a 6 year old child as a late post-operative complication of duodenoduodenostomy (for duodenal atresia in the neonatal period). To the best of our knowledge this is the first case of its kind reported in English literature. Cholecystectomy followed by choledocholithotomy was done and the patient had an uneventful recovery. Upper abdominal pain in any patient with a history of surgery for duodenal atresia in the past warrants a thorough evaluation for any biliary tract anomaly, cholecystitis, cholangitis, cholelithiasis or choledocholithiasis.

Tan HL, Jones PG, Auldist AW. Gallstones and duodenal atresia. Ann Acad Med Singapore 1985;14(4):604-8.

Tchirkow G, Highman LM, Shafer AD. Cholelithiasis and cholecystitis in children after repair of congenital duodenal anomalies. Arch Surg 1980;115(1):85-6.

Agnifili A, Gola P, Marino M, Carducci G, Mancini E, Verzaro R, Lotti R, Tollis G, Placidi S, Criscione S, Palermo P, Rizzo FM. Biliary lithiasis in childhood. A spectrum of diseases with different clinical significance during fetal life, childhood and adolescence. Minerva Pediatr 1998;50(4):127-36.

Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol 2006;20(6):1075-83.

Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd, Engum SA, Rouse TM, Billmire DF. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg 2004;39(6):867-71; discussion 867-71. Review.

Piessen G, Mariette C, Aubry E, Triboulet JP. Duodenal atresia and choledochal cyst: a rare combination. Gastroenterol Clin Biol 2006;30(8-9):1085-9.

Lochbühler H, Joppich I, Diehm T. Abnormalities of the common bile duct and Vater's papilla in various forms of duodenal atresia. Z Kinderchir 1989;44(1):13-6.

Sugimoto T, Yamagiwa I, Obata K, Ouchi T, Takahashi R, Suzuki R, Shimazaki Y. Choledochal cyst and duodenal atresia: a rare combination of malformations. Pediatr Surg Int 2004;20(9):724-6. Epub 2004 Aug 20.

Panuel M, Bourliere-Najean B, Delarue A, Viard L, Faure F, Devred P. Duodenal atresia with bifid termination of the common bile duct. Arch Fr Pediatr 1992;49(4):365-7.

Vitetta L, Little P, Nayman J, Elzarka A. Primary “Brown Pigment” Bile Duct Stones. HPB Surg 1991;4(3):209-20; discussion 221-2.

Grace PA, Poston GJ, Williamson RC. Biliary motility. Gut 1990;31(5):571-82.

Zhang ZH, Wu SD, Wang B, Su Y, Jin JZ, Kong J, Wang HL. Sphincter of Oddi hypomotility and its relationshipwith duodenal-biliary reflux, plasma motilin and serum gastrin. World J Gastroenterol 2008;14(25):4077-81.

Deng ZL, Nabae T, Konomi H, Takahata S, Yokohata K, Ogawa Y, Chijiiwa K, Tanaka M. Effects of proximal duodenal transection and anastomosis on interdigestive sphincter of Oddi cyclic motility in conscious dogs. World J Surg 2000;24(7):863-9.

Ahrendt SA, Pitt HA. Biliary tract. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery: The Biological Basis of Modern Practice. 17th ed. Philadelphia: Saunders; 2004. p.1597-641.

Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S. Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis. Gastrointest Endosc 2002;56(6):885-9.

Cohen S, Kalinin M, Yaron A, Givony S, Reif S, Santo E. Endoscopic ultrasonography in pediatric patients with gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2008;46(5):551-4.

Lee YT, Sung J. Choledocholithiasis . In: Baron TH, Kozarek R, Carr-Locke DL, editors. ERCP. New Delhi:Saunders; 2008. p. 357-66.

Tipnis NA, Werlin SL. The use of magnetic resonance cholangiopancreatography in children. Curr Gastroenterol Rep 2007;9(3):225-9.

Hekimoglu K, Ustundag Y, Dusak A, Erdem Z, Karademir B, Aydemir S, Gundogdu S. MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis 2008;9(3):162-9.

Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancreatography of biliary system abnormalities in children. Clin Imaging 2007;31(2):93-101.

Munir K, Bari V, Yaqoob J, Khan DB, Usman MU. The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice. J Pak Med Assoc 2004;54(3):128-32.

Schaefer JF, Kirschner HJ, Lichy M, Schlemmer HP, Schick F, Claussen CD, Fuchs J. Highly resolved freebreathing magnetic resonance cholangiopancreatography in the diagnostic workup of pancreaticobiliary diseases in infants and young children: initial experiences. J Pediatr Surg 2006;41(10):1645-51.

Issa H, Al-Haddad A, Al-Salem AH. Diagnostic and therapeutic ERCP in the pediatric age group. Pediatr Surg Int 2007;23(2):111-6. Epub 2006 Dec 6.

Durakbasa CU, Balik E, Yamaner S, Bulut T, Büyükuncu Y, Sökücü N, Akyüz A, Bugra D. Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children and adolescents: experience in a single institution. Eur J Pediatr Surg 2008;18(4):241-4. Epub 2008 Aug 14.

Prasil P, Laberge JM, Barkun A, Flageole H. Endoscopic retrograde cholangiopancreatography in children: A surgeon's perspective. J Pediatr Surg 2001;36(5):733-5.

NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 2002;19(1):1-26.

Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2006;(2):CD003327.

Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol 2002;97(11):2763-7.

Bonnard A, Seguier-Lipszyc E, Liguory C, Benkerrou M, Garel C, Malbezin S, Aigrain Y, de Lagausie P. Laparoscopic approach as primary treatment of common bile duct stones in children. J Pediatr Surg 2005;40(9):1459-63.

Kharbutli B, Velanovich V. Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg 2008;12(11):1973-80. Epub 2008 Aug 6.

Waldhausen JH, Graham DD, Tapper D. Routine intraoperative cholangiography during laparoscopic cholecystectomy minimizes unnecessary endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 2001;36(6):881-4.

La Greca G, Barbagallo F, Di Blasi M, Di Stefano M, Castello G, Gagliardo S, Latteri S, Russello D. Rendezvous technique versus endoscopic retrograde cholangiopancreatography to treat bile duct stones reduces endoscopic time and pancreatic damage. J Laparoendosc Adv Surg Tech A 2007;17(2):167-71.

Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005;11(4):593-6.

Kim TH, Oh HJ, Choi CS, Yeom DH, Choi SC. Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser. World J Gastroenterol 2008;14(18):2863-6.

Files
IssueVol 49, No 4 (2011) QRcode
SectionOriginal Article(s)
Keywords
Duodenal atresia Cholangitis Choledocholithiasis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Zaka-ur-Rab A, Zaka-ur-Rab Z, Fareed R, Ahmed I. Cholangitis and Choledocholithiasis after Repair of Duodenal Atresia: A Case Report. Acta Med Iran. 1;49(4):269-274.