Korean J Gastroenterol.  2016 Mar;67(3):150-152. 10.4166/kjg.2016.67.3.150.

Common Bile Duct Obstruction Due to a Large Stone at the Duodenal Stump

• Shin JK
• Choi SH
• Hong SD
• Kim S
• Cho HJ
• Hong HJ
• Kim HK
• Ko KH

• KMID: 2373416
• DOI: http://doi.org/10.4166/kjg.2016.67.3.150

Abstract

Enterolith is a rare complication of Billroth II gastrectomy. Most enterolith cases have been reported in association with diverticula, tuberculosis, and Crohn's disease. We report the case of a huge enterolith that developed in the duodenal stump following common bile duct obstruction and cholangitis, necessitating surgery. The enterolith was clearly visible on the abdominal computed tomography. It was removed through a duodenotomy. The surgery was successful without any significant complications.

Keyword

Enterolith; Duodenal stump; Cholangitis

MeSH Terms

Abdomen/diagnostic imaging
Aged
Cholestasis/*diagnosis/etiology/surgery
Duodenal Diseases/*diagnosis/etiology/surgery
Female
Gallstones/complications/diagnosis
Gastroenterostomy
Humans
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Computed tomography scans of the abdomen. It shows a 4.8 cm sized, large, and calcified stone at a duodenal stump (A; arrow) and a dilated common bile duct, about 1.8 cm in diameter (B; arrow).

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  Fig. 2. Cystic duct and common bile duct were clear, while no visible passage of contrast medium to the duodenum was seen on tubogram.

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  Fig. 3. (A) Under laparoscopy, the duodenal stump was enlarged and filled with a large mass. (B) While gallbladder stones were black, small and multiple (white arrow), the enterolith in the duodenum was about 5 cm-size big brownish stone, which was cru-shed into several pieces for extraction during the operation (black arrow head).

Reference

References

1. Tien YW, Lee PH, Chang KJ. Enterolith: an unusual cause of afferent loop obstruction. Am J Gastroenterol. 1999; 94:1391–1392.

2. Shocket E, Simon SA. Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum: a case report and review of the literature. Am J Gastroenterol. 1982; 77:621–624.

3. Gadhia U, Raju D, Kapoor R. Large enterolith in a meckels diverticulum causing perforation and bowel obstruction: an interesting case with review of literature. Indian J Surg. 2013; 75(Suppl 1):177–179.

4. Monchal T, Hornez E, Bourgouin S, et al. Enterolith ileus due to jejunal diverticulosis. Am J Surg. 2010; 199:e45–e47.

5. Cartanese C, Campanella G, Milano E, Saccò M. Enterolith causing acute afferent loop syndrome after Billroth II gastrectomy: a case report. G Chir. 2013; 34:164–166.

6. Kim HJ, Moon JH, Choi HJ, et al. Endoscopic removal of an enterolith causing afferent loop syndrome using electrohydraulic lithotripsy. Dig Endosc. 2010; 22:220–222.

7. Tan WS, Chung AY, Low AS, Cheah FK, Ong SC. Enterolith formation in the roux limb hepaticojejunostomy. Dig Dis Sci. 2007; 52:3214–3216.

8. Carbognin G, Biasiutti C, El-Khaldi M, Ceratti S, Procacci C. Afferent loop syndrome presenting as enterolith after Billroth II subtotal gastrectomy: a case report. Abdom Imaging. 2000; 25:129–131.

9. Sartori N, Falconi M, Contro C, Bassi C, Pederzoli P. Symptomatic stone in the duodenum after gastrectomy. Surgery. 2001; 129:238–239.