Sump syndrome following choledochoduodenostomy and its endoscopic treatment

Baker, A. R.; Neoptolemos, John P.; Carr‐Locke, David L.; Fossard, D. P.

doi:10.1002/bjs.1800720606

Cited by 59 publications

(24 citation statements)

References 18 publications

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“…However, since biliary bacterial contamination occurs universally following CDD [10], there must also be concomitant impairment in biliary drainage in order to result in elevated biliary tree pressures that are required for the spillover of bacteria-rich bile into the systemic circulation [11,12]. It follows that, for drainage to be impaired with CDD, stenosis of the anastomotic site is necessary, with ampullary drainage already previously limited.…”

Section: Discussionmentioning

confidence: 99%

“…Reported complications of sump syndrome may include cholangitis, pancreatitis, hepatic abscesses, and secondary biliary cirrhosis, and likely correlate with the extent and duration of biliary stasis and subsequent obstruction. Occasionally, sump stagnation may result in bile salt deconjugation, leading to bacterial proliferation, malabsorption, and steatorrhea [10,12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Studies report a low sump syndrome rate of 2.5% [3], ranging from 0 to 9.6% in the largest series [12][13][14]. Although sump syndrome does not require cholangitis or hepatic abscess formation for diagnosis, some series have relied on these complications for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The true incidence of sump syndrome may, therefore, be under-reported [3]. The syndrome is thought to result in abnormal liver function tests in some cases [12]. Additional laboratory abnormalities depend on further complications, such as abscess formation and pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sump Syndrome as a Complication of Choledochoduodenostomy

et al. 2011

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“…Lateral choledochoduodenostomy is a very effective way to treat stones in the common bile duct with low mortality and morbidity 1,6 . Long term complications are rare and related to stenosis of the anastomosis and due to sump syndrome 2,4,5,7,8 . Sump syndrome is a rare complication and is due to retention of food, debris and stones in the distal portion of the choledochus, between the papilla and the surgical stoma.…”

Section: Introductionmentioning

confidence: 99%

Relato de caso de cálculo de colédoco em forma de cigarro: uma rara complicação após coledocoduodenostomia

Reis

Axon

2010

ABCD, arq. bras. cir. dig.

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Recurrent Cholangitis With and Without Anastomotic Stricture After Biliary-Enteric Bypass

Matthews

Baer²,

Schweizer³

et al. 1993

Arch Surg

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We recently surgically treated 24 patients incapacitated by recurrent cholangitis after biliary-enteric anastomosis performed for benign disease. Contrary to commonly held dogma, as many as one third of the patients had no evidence of anastomotic stricture indicated by radiologic and operative findings. We identified several other primary and coexistent pathogenetic factors including intrahepatic stricture in 42% of the patients, intrahepatic calculi in 25%, improperly constructed enteric conduits in 13%, and conditions that predispose to bacterial overgrowth in the biliary tree in 17%. Seventy-one percent of the patients had multiple etiologic factors, and of those patients without demonstrable anastomotic stricture, intrahepatic stricture was particularly common. Seventy-one percent remained symptom-free in their first year after operation. The most difficult situation to manage, and the factor responsible for most recurrences after our reoperation, involved intrahepatic stricture. A combined surgical and interventional radiologic approach to complex cases may be useful in selected patients.

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Sump syndrome following choledochoduodenostomy and its endoscopic treatment

Cited by 59 publications

References 18 publications

Sump Syndrome as a Complication of Choledochoduodenostomy

Sump Syndrome as a Complication of Choledochoduodenostomy

Relato de caso de cálculo de colédoco em forma de cigarro: uma rara complicação após coledocoduodenostomia

Recurrent Cholangitis With and Without Anastomotic Stricture After Biliary-Enteric Bypass

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