Roux-en-Y choledochojejunostomy is a common biliary reconstruction procedure.The collection of gallstones in the jejunal limb is a rare complication.Here we present a case of a 61-year-old Chinese female who received ...Roux-en-Y choledochojejunostomy is a common biliary reconstruction procedure.The collection of gallstones in the jejunal limb is a rare complication.Here we present a case of a 61-year-old Chinese female who received Roux-en-Y choledochojejunostomy 10 years ago.Diagnosis of recurrent bile duct stones accompanying infection was made before operation.She also had an abdominal mass which was possibly an intussuscepted colon or a huge fecolith.At laparotomy,an oval stone(5 cm in diameter) and 3 smaller multifaceted stones(2 cm in diameter) were found in the jejunal limb.A fistula between this jejunum and colon was also found.Although the typical manifestations of diarrhea were present,the diagnosis of a biliary colonic fistula was missed before operation.Partial colectomy was performed with the fistulous opening repaired.A T-tube was left in the jejunal limb and the mesocolon aperture was enlarged and revised.Her postoperative convalescence was uneventful.We report this case hoping to sharpen our diagnostic acumen.展开更多
OBJECTIVE: To evaluate the results of palliative surgical treatment of hilar cholangiocarcinoma in terms of quality of life, survival period and cholangitis rate. MFTHODS: The clinical data on 232 patients with hilar ...OBJECTIVE: To evaluate the results of palliative surgical treatment of hilar cholangiocarcinoma in terms of quality of life, survival period and cholangitis rate. MFTHODS: The clinical data on 232 patients with hilar cholangiocarcinoma in the last 22 years were analyzed retrospectively. Palliative operations included extrahepatic or intrahepatie choledochojejunostomy (123 patients), bridge internal drainage (15), endoscopic biliary drainage (49), percutaneous transhepatic biliary drainage or celiotomy biliary drainage (29), and exploratory celiotomy external drainage (16). RESULTS: In this series, the operative mortality rate was 9.1%, and no significant difference was observed between groups. The rate of cholangitis after operation was significantly lower in Roux-en-Y choledochojejunostomy group (16.2%) and bridge internal drainage group (15.4%) than in internal drainage group (35.5%, P<0.01), including percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary drainage (ERBD), and celiotomy (or PTBD) external biliary drainage group (39.1%, P<0.01). No significant difference in survival was observed between the Roux-en-Y choledcthojejunostomy group (9.3±1.8 months) and PTBD (or ERBD) internal drainage group (8.7±2.2 months), but the survivals of the above groups were significantly longer than those of the bridge internal drainage group (6.5±1.7 months, P<0.05) and celiotomy (or PTBD) external biliary drainage group (4.4±2.1 months, P<0.01). CONCLUSIONS: In unresectable cholangiocarcinomas, either operative bilioenteric bypass or percutaneous transhepatic biliary drainage can achieve significant palliation. Roux-en-Y choledochojejunostomy is the best choice for palliative operation. The use of U-tube is recommended for internal radiation therapy.展开更多
文摘Roux-en-Y choledochojejunostomy is a common biliary reconstruction procedure.The collection of gallstones in the jejunal limb is a rare complication.Here we present a case of a 61-year-old Chinese female who received Roux-en-Y choledochojejunostomy 10 years ago.Diagnosis of recurrent bile duct stones accompanying infection was made before operation.She also had an abdominal mass which was possibly an intussuscepted colon or a huge fecolith.At laparotomy,an oval stone(5 cm in diameter) and 3 smaller multifaceted stones(2 cm in diameter) were found in the jejunal limb.A fistula between this jejunum and colon was also found.Although the typical manifestations of diarrhea were present,the diagnosis of a biliary colonic fistula was missed before operation.Partial colectomy was performed with the fistulous opening repaired.A T-tube was left in the jejunal limb and the mesocolon aperture was enlarged and revised.Her postoperative convalescence was uneventful.We report this case hoping to sharpen our diagnostic acumen.
文摘OBJECTIVE: To evaluate the results of palliative surgical treatment of hilar cholangiocarcinoma in terms of quality of life, survival period and cholangitis rate. MFTHODS: The clinical data on 232 patients with hilar cholangiocarcinoma in the last 22 years were analyzed retrospectively. Palliative operations included extrahepatic or intrahepatie choledochojejunostomy (123 patients), bridge internal drainage (15), endoscopic biliary drainage (49), percutaneous transhepatic biliary drainage or celiotomy biliary drainage (29), and exploratory celiotomy external drainage (16). RESULTS: In this series, the operative mortality rate was 9.1%, and no significant difference was observed between groups. The rate of cholangitis after operation was significantly lower in Roux-en-Y choledochojejunostomy group (16.2%) and bridge internal drainage group (15.4%) than in internal drainage group (35.5%, P<0.01), including percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary drainage (ERBD), and celiotomy (or PTBD) external biliary drainage group (39.1%, P<0.01). No significant difference in survival was observed between the Roux-en-Y choledcthojejunostomy group (9.3±1.8 months) and PTBD (or ERBD) internal drainage group (8.7±2.2 months), but the survivals of the above groups were significantly longer than those of the bridge internal drainage group (6.5±1.7 months, P<0.05) and celiotomy (or PTBD) external biliary drainage group (4.4±2.1 months, P<0.01). CONCLUSIONS: In unresectable cholangiocarcinomas, either operative bilioenteric bypass or percutaneous transhepatic biliary drainage can achieve significant palliation. Roux-en-Y choledochojejunostomy is the best choice for palliative operation. The use of U-tube is recommended for internal radiation therapy.
