Korean J Hepatobiliary Pancreat Surg.  2015 May;19(2):78-81. 10.14701/kjhbps.2015.19.2.78.

Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report

• Lee HG
• Hwang S
• Joo YH
• Cho YJ
• Choi K

• KMID: 2243054
• DOI: http://doi.org/10.14701/kjhbps.2015.19.2.78

Abstract

The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

Keyword

Gallstone; Ileus; Roux-en-Y jejunostomy; Biliary obstruction; Bile duct cancer

MeSH Terms

Aged
Bile Duct Neoplasms*
Diagnosis
Female
Follow-Up Studies
Gallstones*
Humans
Ileus*
Incidence
Intestines
Jaundice, Obstructive*
Liver Function Tests
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Initial computed tomography finding showing a radiopaque stone (arrow) at the upstream afferent loop bowel (A) with concentric bowel wall thickening and dilatation of the segmental jejunal loop (B).

• 

  Fig. 2 Follow-up computed tomography finding showing disappearance of intraluminal radiopaque lesion (A) with mild distension and edematous wall thickening of the afferent bowel loop (B).

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