Biliodigestive anastomosis stricture

After choledocho- and hepaticojejunostomy, anastomotic stricture may develop. The need for further treatment - surgical or X-ray - occurs in approximately 20-25% of cases. Recurrence of strictures is noted in 65% of cases within 2 years and in 90% of cases within 5 years. If there are no symptoms 4 years after surgery, the probability of complete recovery is 90%. As the number of operations performed increases, the lot indicator decreases, but the probability of a successful outcome after many attempts at correction still exists.

Symptoms of biliodigestive anastomosis stricture

Clinical signs of biliodigestive anastomotic stricture include fever, chills, and jaundice, and pain may be present. Flu-like episodes may precede this. Cholangitis does not necessarily indicate restenosis and may be seen with intrahepatic strictures or stones, or with inadequate release of a bowel loop.

Laboratory research

During the acute phase examination, leukocytosis and changes in liver function tests are detected, often with a transient increase in transaminase activity (due to short-term acute obstruction) and subsequent increase in alkaline phosphatase and GGT activity.

X-ray examination

Plain abdominal radiography may detect air in the bile ducts and localize the stricture. The presence of air in the bile ducts does not necessarily indicate complete patency of the anastomosis. Duct dilation, which may be seen on ultrasound, is often absent because the obstruction is transient. Percutaneous transhepatic cholangiography reveals an anastomotic stricture. Careful monitoring of the rate of contrast passage through the anastomosis is more important than later radiographs. In cases of prolonged incomplete obstruction with recurrent cholangitis, changes characteristic of secondary sclerosing cholangitis may be seen.

ERCP can be used to study the choledochoduodenostomy. Another approach to the anastomosis in the area surrounding the liver is percutaneous access through a loop of intestine fixed under the skin.

Evaluation of patients with cholangitis in the presence of a normally functioning anastomosis is extremely challenging because no imaging technique can identify the cause of cholangitis.

Treatment of stricture of biliodigestive anastomosis

Surgical and non-surgical methods of treatment are used. Usually, percutaneous access to the bile ducts is the only possible one. Joint work of a group of specialists - surgeons and radiologists - is of great importance.

In chronic cholestasis, additional administration of fat-soluble vitamins may be required.

[ 1 ], [ 2 ]