Heterotaxy syndrome and biliodigestive anastomosis with migration of biliar prosthesis

Gila, Juan de Dios López-González; Garófano-Jerez, José Maximiliano; Benedicto-Hernández, Elena; Jerez, Antonio Paulino Garófano; Garrido, Juan de Dios López-González

doi:10.15406/ghoa.2020.11.00405

Cited by 1 publication

(4 citation statements)

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“…Distally migrated stents normally pass through the gastrointestinal tract (86% of cases). 10,14,15,16 For this reason, initial management for the patient was expectant, with thorough and prolonged follow-up by abdominal x-rays 17 (Figure 6). A lower percentage of prostheses remain in the intestine without symptoms 10,14,15,16 as in the presented case.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,14,15 The presence of patient abdominal comorbidities, for example, adhesions, diverticular disease and/or hernias, is associated to a higher risk of complications. 10,11,15,17 Patients with biliary endoprostheses should be followed up clinically and with imaging, endoscopy or x-ray tests. 3 In patients with biliary prostheses and abdominal pain or sepsis, differential diagnosis with perforation should be considered and abdominal x-rays performed.…”

Section: Biliary Stentsmentioning

confidence: 99%

“…i. In the absence of impaction or perforation, two approaches are possible: 17 a. Expectant treatment, since most foreign bodies pass through the intestine without incident. This requires thorough and prolonged follow-up with repeated abdominal x-rays.…”

Section: B Prosthesis Migration Into the Colonmentioning

confidence: 99%

“…16 In cases of limited perforation and absence of peritonitis, endoscopic extraction has been proposed as the standard treatment. 17 In order to avoid complications, it is generally recommended that the migrated prosthesis should be removed immediately, either by endoscopic, percutaneous or mixed technique. 21 The surgical approach is no longer recommended and it is reserved for situations when previous techniques have failed.…”

Section: B Prosthesis Migration Into the Colonmentioning

confidence: 99%

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Background: Endoscopic stent insertion is a primary technique for the decompression of obstructed biliopancreatic duct system. Distal migration of biliary stents is considered a rare complication. When this happens, prostheses normally pass spontaneously through the gastrointestinal tract or remain in the intestine without symptoms, but sometimes the migration of the stent can lead to impaction and cause problems. A biliodigestive anastomosis is a surgical connection between the common bile duct and the digestive tract to prevent interference of bile flow. This surgery may be performed for several different reasons, including management of the injury of the biliary tract. Roux-en-Y hepaticojejunostomy is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. Heterotaxy is a rare syndrome characterized by an abnormal arrangement of the internal organs in the chest and abdomen. Despite its variable presentation, heterotaxy syndrome can be classified into heterotaxy with polysplenia or left isomerism, and heterotaxy with asplenia or right isomerism. Case presentation: We present the case of a 42-year-old male with heterotaxy with polysplenia who underwent laparoscopic cholecystectomy for cholelithiasis. The reconstruction of the bile duct was performed as a result of the complete section of the common hepatic duct during surgery. The next six years, he presented with recurrent episodes of cholangitis that required dilation of the stenosis and the placement of biliary stents through ERCP. However, the patient required a Roux-en-Y biliodigestive anastomosis during which distal migration of the biliary stent occurred, The prosthesis remained in the duodenum for several months without showing clinical symptoms, until it was removed by endoscopy using a polypectomy handle. Conclusion: This is a unique case in the literature for heterotaxy and the patient's surgical history, in which distal migration of the biliary stent occurs during surgical manipulation in the biliodigestive shunt. The jejunojejunal anastomosis is an area where the stent can easily be stopped.

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