Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
ABSTRACT
A 53-year-old female was admitted to our hospital due to epigastric pain. She underwent hepaticojejunostomy for the treatment of benign common bile duct stricture 5 years ago. She developed choledocholithiasis at anastomosis site 1 year ago and the stones were removed by percutaneous transhepatic cholangioscopy. Abdominal computed tomography revealed multiple stones at the anastomosis site of hepaticojejunostomy. A single balloon enteroscopy (SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) and direct cholangioscopy revealed multiple brown-pigmented stones along the non-absorbable suture materials. The stones were removed using a basket and forceps under the visualization of the direct cholangioscopy using SBE. Any exogenous biliary tract foreign bodies including non-absorbable suture materials after biliary diversion surgery can function as a nidus for stone formation. SBE-assisted ERCP and direct cholangioscopy are useful tools for the treatment of choledocholithiasis formed by suture material in patients with altered anatomy.
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