Endoscopic sphincterotomy and surgical approaches in the treatment of the 'sump syndrome'.

Marbet, Urs A.; Stalder, G; Faust, H.; Harder, F.; K, Gyr

doi:10.1136/gut.28.2.142

Cited by 35 publications

(15 citation statements)

References 6 publications

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“…In addition, endoscopic sphincterotomy can be performed after ERCP. Endoscopic sphincterotomy appears to be the procedure of first choice, because it has morbidity rates similar to those with surgery (5.5%–13.5%) and lower mortality rates (0–1.5% as opposed to 1.5%–11%) 1,13,14. Although ERCP is considered an indispensable diagnostic modality, it was not performed in our patient, because PTBD allowed detailed examination of the biliary tract and the characteristics of the bile, and it seemed difficult to perform endoscopic sphincterotomy in a patient with a periampullary diverticulum.…”

Section: Discussionmentioning

confidence: 99%

Hepatic abscess as a complication of the sump syndrome

Hiura¹,

Kim²,

Ikehara³

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

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We report a case of hepatic abscess associated with the sump syndrome. The patient was a 66-year-old woman who had undergone cholecystectomy and side-to-side choledochoduodenostomy for a common bile duct (CBD) stone in 1983, and who presented with fever and right lower chest pain. A hepatic abscess was diagnosed; after it was drained, percutaneous transhepatic biliary drainage was performed. Bacteriological studies revealed the presence of Bacteroides fragilis and Streptococcus intermedius in the pus in the hepatic abscess cavity, and Klebsiella pneumoniae and Pseudomonas aeruginosa in the bile. The hepatic abscess and cholangitis rapidly resolved in response to two drainage procedures. At surgery, simple closure of the anastomosis was performed, because free drainage was observed from the distal CBD into the duodenum, despite the existence of a periampullary diverticulum.

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Section: Discussionmentioning

confidence: 99%

Hepatic abscess as a complication of the sump syndrome

Hiura¹,

Kim²,

Ikehara³

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

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“…Once the diagnosis is made, the treatment of sump syndrome usually begins with endoscopic sphincterotomy in order to decompress the CBD distally at the level of the ampulla, and this has been reported with good initial success rates [16][17][18][19]. However, endoscopic management may fail because of previous heavy stone burden or benign stricturing disease that necessitated CDD in the first place, or because of new large food particles that pass through the stoma into the CBD which cannot be cleared through a large enough sphincterotomy, as in this case.…”

Section: Discussionmentioning

confidence: 99%

Sump Syndrome as a Complication of Choledochoduodenostomy

et al. 2011

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Case Presentation and EvolutionA 71-year-old man initially underwent open cholecystectomy for biliary colic in 1990. Since then, he had been well until new symptoms began in 2009, when he presented to a community hospital reporting intermittent epigastric pain; ultrasound and computed tomography (CT) scans revealed choledocholithiasis.Because an endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction at that hospital were unsuccessful, the patient underwent exploratory laparotomy with common bile duct (CBD) exploration, during which a CBD stone was removed and a side-to-side choledochoduodenostomy (CDD) was performed.Several months following temporary postoperative relief of his symptoms, the patient developed recurrent episodic right upper quadrant and epigastric pain, but without associated jaundice or fever. He was referred to Stanford University Medical Center, where he was seen by a gastroenterologist for evaluation and further management.His past medical history included atrial fibrillation, hyperlipidemia, diabetes mellitus type II, and vestibular neuritis. Drug history included metoprolol, atorvastatin, metformin, dabigatran, dronedarone, and diltiazem. The patient had no known drug allergies. Socially, the patient did not smoke and enjoyed only occasional alcohol. There was no family history of biliary tract disease.On examination, the patient appeared well and comfortable, was slightly underweight, and had a soft and nontender abdomen. The subcostal incision from his original surgery was visible but appeared well healed. Laboratory findings, including liver function tests, were normal (WBC 7.9, Hb 13.4, Hct 39.4, Plts 257, Na 139, K 3.9, Cl 104, CO2 23, BUN 12, Cr 0.9, PT 15.4, INR 1.3, PTT 48.5, T Bili 0.7, ALT 39, AST 16, Alk P 143, Glu 113, Ca 9.2). An echocardiogram revealed mild mitral, aortic, and tricuspid valve regurgitation, with an ejection fraction of 54%. Magnetic resonance cholangiopancreatography (MRCP) revealed a grossly dilated and tortuous CBD, as well as dilated common hepatic and intrahepatic ducts (Fig. 1a). A fluid-debris level was also seen in the CBD (Fig. 1b).Endoscopy revealed a patent side-to-side CDD anastomosis that could be entered with the gastroscope (Fig. 2). Moderate amounts of vegetable debris were seen in the CBD, and were removed using a rat-toothed forceps (Fig. 3). Using a duodenoscope, the CBD was also cannulated through the ampullary orifice and contrast injection showed an 18-mm-wide CBD with contrast extravasation through the stoma. Filling defects revealed further debris in the distal CBD, which were cleared using a balloon catheter through the CDD.Following ERCP, the patient was immediately relieved of his symptoms. However, within a few days, the symptoms recurred, and, again, included epigastric pain without jaundice or fever. Multiple further ERCPs were necessary, each revealing similar findings of vegetable debris within the CBD. Despite clearing the CBD during each procedure, the debris re-accumulated and symptoms always recurred.

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“…ES has been regarded as the treatment of choice based on several studies [16,17]. ERCP and ES allowed for a precise diagnosis and for definitive treatment in all of 11 patients with sump Cholangitis has significant potential for mortality and morbidity, especially if left untreated.…”

Section: Discussionmentioning

confidence: 99%