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Stricture of bioliodigestive anastomosis
Last reviewed: 23.04.2024
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After choledocho- and hepatocojunostomy, the development of anastomotic stricture is possible. The need for further treatment - surgical or roentgenosurgical - occurs in approximately 20-25% of cases. Relapses of strictures are noted in 65% of cases for 2 years and in 90% of cases for 5 years. If there are no symptoms 4 years after surgery, the probability of complete cure is 90%. As the number of completed operations increases, the indicator decreases, but the probability of a successful outcome after many attempts at correction still exists.
Symptoms of stricture of biliodigestive anastomosis
Clinical signs of stricture of biliodigestive anastomosis are fever, chills and jaundice, and pain syndrome is possible. Before this, there may be episodes of influenza-like state. Cholangitis does not necessarily indicate restenosis and can be observed with intrahepatic strictures or stones, as well as in inadequate bowel loosening.
Laboratory research
When examining the acute phase, leukocytosis and changes in liver function parameters are detected, often with a transient increase in the activity of transaminases (due to short-term acute obstruction) and subsequent increase in the activity of alkaline phosphatase and GGTP.
X-ray examination
Survey radiography of the abdominal cavity allows you to detect air in the biliary tract and clarify the localization of the stricture. The presence of air in the biliary tract does not necessarily indicate the complete patency of the anastomosis. Expansion of the ducts, which can be detected with ultrasound, is often absent due to the transient nature of the obstruction. Percutaneous transhepatic cholangiography reveals anastomotic stricture. Thorough observation of the rate of passage of contrast medium through anastomosis is more important than later radiographs. With prolonged incomplete obstruction with relapses of cholangitis, changes that are characteristic of secondary sclerosing cholangitis can be detected.
ERCP can be used to investigate the choledochoduodenoanastomosis. Another approach to anastomosis in the region of the liver of the liver is percutaneous access through the bowel loop fixed under the skin.
Examination of patients with cholangitis with a normally functioning anastomosis is an extremely difficult task, since none of the imaging methods reveals the cause of cholangitis.
Treatment of stricture of bioliodigestive anastomosis
Operative and non-operative methods of treatment are used. Usually, percutaneous access to the biliary tract is the only possible way. Important is the joint work of a group of specialists - surgeons and radiologists.
Chronic cholestasis may require additional administration of fat-soluble vitamins.
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