Posted on Authorea 5 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160193278.86359940/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. lo Weledji Elroy report. case by a managed hepaticoduodenostomy: stone duct bile common Impacted ehdabodpesr f139 mg er aeo 1basmn eprtr aeo 2breaths/min 22 of rate examination, respiratory On beats/min, disease. 81 liver of chronic rate for heart factors mmHg, pale 37.2 risk 153/92 no of nor but of managed temperature urine history no was pressure a dark medical which were and a blood years with past There a jaundice 6 relevant had was chest. past no there he and the had and back in fever He of pain the onset complained abdominal to stool. gradual he recurrent radiated of occasion had history this and 3-week He On constant conservatively. a factors. nature, with relieving in emergency or an burning exacerbating as was admitted which was pain farmer epigastric African checklist. black reporting fit CARE 40-year-old the A with open accordance in an case complicated following stump had the Presentation duct present stone Case We cystic ligated impacted bile. dehisced and of the pressure retained from back leakage This to biliary causing due stone. or by choledochoduodenostomy, cholecystitis CBD a acute hepaticoduodenostomy 3]. distal out a for cholecystectomy carry herein [2, impacted setting, present and We an approach resource is low [4]. for it ideal sphincteroplasty a where performed transduodenal in the stone a the stone the through to CBD and leaving stone the impacted either as time removing availability, entail distally consensus will equipment a approach For experience, no open [3]. personal an is cholangiography expertise on departmental retrograde there depend other endoscopic clearance, of will availability over chosen duct the strategy grounds and Although management gained sphincterotomy cholangiogram The 1[1]. has per-operative and figure stones selective ERCP) in or CBD illustrated ( routine for is available a cholangiopancreatogram the exploration showing following retrograde laparoscopic algorithm stones endoscopic An pre-operative CBD established. a of well or management is stones the of (CBD) for presence duct strategies bile the common in of management especially The stone CBD distal impacted Introduction choledochoduo- retained, traditional the the to of alternative management an sepsis. be the may hepaticoduodenotomy in a denostomy as such procedure bypass A message Clinical obstruction. Key dehiscence biliary the distal causing of by a result cholecystitis with acute a setting for as resource cholecystectomy low stump open a duct an in cystic complicated stone the had CBD of stone distal impacted impacted This retained, a outcome. for good performed hepaticoduodenotomy a herein present We Abstract 2020 5, October 2 1 hlcsii ihadsal matn B tn.Afl lo on n ea ucintsswr normal. were tests function renal and count blood acute full an A demonstrated scan stone. ultrasound CBD abdominal impacting An distally a cholecystitis. with acute cholecystitis an with consistent sign Murphy’s ib einlHospital Regional Limbe Buea of University 1 dfruh Mbengawoh Ndiformuche , 0 .H a nitrcslr n edrrgthphnra aswt positive a with mass hypchondrial right tender a and sclera icteric an had He C. 2 n rn Zouna Frank and , 1 1 Posted on Authorea 5 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160193278.86359940/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. opiain uha deiebwlosrcin nsooi ekg n etcucr pr o higher for Apart ulcer. peptic fewer and of leakage the because anastomotic to cyst obstruction, alternative choledochal bowel an a adhesive becoming of is as excision has after (HD) such stone reconstruction Hepaticoduodenostomy complications the duct in thus bile literature. (HJ) and, common English obstructive hepaticojejunostomy anastomoses the for intestinal jaun- Roux-en-Y in as hepaticoduodenostomy the reported easily A significant as seal been [10]. for not successful not drain Except do was sub-hepatic anastomoses a [9]. outcome Biliary for formation the indication resolved. conservatively, stone rigors cm managed further and 2.5 was pain and least dice, at cholangitis which is recurrent leakage choledocho/hepaticoduodenostomy hepaticoduodenostomy) stenosis, biliary the ( avoid that post-operative approach to ensure long-term higher to order dehisced essential a good in is re-sutured below, has long It the adhesions and of 2). and obstruction (Figure Because inflammation CBD utilized the [8]. was lower and, CDD syndrome of stump ‘sump’ to-side decompression the duct side- the including cystic The the for complications into abscess. contents infrequent procedure hepatic duodenal with definitive of or results “sump” and reflux cholangitis and and safe in stasis pancreatitis a resulting bile overgrowth, recurrence, is from bacterial stone occur with to due abscess, more CBD theorized method a hepatic is terminal therapeutic as syndrome cholangitis, obsolete ‘Sump’ reported an reflux low as morbidity, been [7]. with regarded syndrome has higher groups but It age of drainage all [6]. T-tube fears in than accomplished to in stones CBD, was had effective CBD dilated anastomosis or highly of (CDD) a wide malignancy, as treatment of choledochoduodenostomy a effective CDD by presence provided demonstrated A the caused mortality study in and obstruction prospective setting. stones) morbidity recent CBD (CBD A resource choledocholithiasis with low [5]. for patients seque- stones treatment a in adverse impacted in with the palliation patients stone rescue for elderly to CBD indicated used distal been being impacted traditionally procedure an hepaticoduodenostomy of open lae an the demonstrates of nature case the This passed. assess But spontaneously to had planned operation. calculi was initial the the scan Discussion if after CT ascertain month contrast and a follow-up discharged tree a symptoms was biliary surgery The difficulties, patient extrahepatic The weeks. financial the 2 this inserted. patient’s and about Following was resolved the in drain fever subsided cm. for sub-hepatic which and 2.5 anastomosis A pain least the At necessary. jaundice, from at not of leak (vicryl). of was biliary material severe diameter CBD to absorbable by the stoma side- complicated 3/0 of and a was This of drainage CHD, with sutures transversely. T-tube the shaped continuous a sutured diamond- in of procedure, then layer was made was one anastomosis was which a the incision opted duodenum in completion vertical we adjacent performed A CBD, was the the anastomosis in hepaticoduodenostomy. side transduodenal surrounding made a adhesions a incision in and longitudinal performing approach stump bulb) a proximal from duct (duodenal hepatico- more cystic decision a duodenum a inflamed or our the cholechoduodenostomy for the changed (a of of 2.0 procedure This Because aspect bypass with CBD. forward resutured duodenostomy). upper straight dilated doubly more the was the a allowed severe This to against sphincterotomy/plasty revealed duodenum, adhesions. laparotomy comfortably the dense emergency lie with of difficult to stump A Kocherisation duct Full normal. impacted cystic was an dehisced pancreas volumi- vicryl. and, the The a cc CBD. from revealed 682 the leak scan measuring of biliary (CT) collection base tomography purulent the computed peritoneal at contrast perihepatic calculi antibiotics, A and intravenous hypochondrial wound. with right abdominal aggressively nous midline if 20 post treated healing CBD the 9th was the the On the which via physiotherapy. of On chest exploration pneumonia performed. and the basal post-operative was therapy or cholecystectomy by developed oxygen stone, followed retrograde he CBD sepsis difficult day the distal A gallbladder anaesthetically, operative the the unstable symptomatic. of was treat remained patient passage initially patient the spontaneous to the gallbladder As possible made palpable dilated. the was not no for approach was observation was staged CBD con- There a the he CBD. for and, , acutely stone decision the an duct K on was bile vitamin there raised impacting common Following operation, intramuscular nor gallbladder with At 0-42). and gangrenous sphincterotomy/plasty. picture (n: antibiotics transduodenal intrahepatic, obstructive 32ui/l a spectrum in th 2 otoeaiedyteewsasde iir leakage biliary sudden a was there day operative post Posted on Authorea 5 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160193278.86359940/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. eotn hcls:Teatoshv opitdteCR checklist CARE the References complieted have authors The Checklist: Reporting Footnote in None revised Fundings: (as Declaration questions Helsinki patient. that the the from wth All ensuring Acknowledgements obtained and resolved. in was standards and committee/s ethical consent work investigated research the informed appropriately with Written the national are accordance 2013). and/or work of in were the institutional aspects participants of the human part all involving of any studies for of in integrity performed accountable or procedures are accuracy the authors to The related duct statement: bile Ethical common supraduodenal the around adhesions [16]. an Declarations and distal setting be impacted sepsis resource may trial retained, low of a hepaticoduodenotomy a the presence in a to of the and, management as exceptions in the such few especially in procedures stone are choledochoduodenostomy bypass CBD there traditional that open and the fact However, laparoscopic to the alternative is approach. by laparoscopic gallstones corroborated a symptomatic is and laparoscopic of for This ERCP (i.e. impacted over treatment simultaneously (Figure exploration). patient with stone/s standard the CBD indicated CBD patients the and for intra-operative is in advantage gallbladder laparoscopic the the exploration procedures with and has deal open com- cholecystectomy open approach to laparoscopic an laparoscopic to able in being the conversion failed by Generally, basket avoid sphincterotomy it appropriate stone 15]. may if an impacted [3, the (LCBDE) the and stones but to exploration CBD of lithotripsy case, damage retrieval duct laser of for this of the bile sphincterotomy risk utilization in mon of and the rational useful ERCP division also the the post- been [1].Currently, allow is A and have 1) There to tree 13]. would CBD biliary [14]. [1, available the vein instrumentation the if to overzealous portal down damage by or passed operative include artery passage Desjardin The sphincteroplasty be hepatic a false transdudenal using a can possible. a stone of that this distal in production impacted make dilator sphincter an biliary not Bake’s retrieving and did a for papilla setting duct or our bile forceps, common in the (choledoscope) (stone-grasping) balloons instruments exploring or fibreoptic blindly Thus intensifier), the baskets in cholecystectomy. (image CBD exploring hazards wire fluoroscopy of and the of time guided lack cholecystectomy the in radiologically The a at stones or treated stone. during Approximately have any are cholangiography retrieve also stones [12]. intra-operative to CBD will reported CBD performing with stones been of patients most recently gallbladder importance that also symptomatic the appropriate [11]. has for is outcome syndrome It surgery and Mirizzi’s benefits undergoing [13]. IV operative patients type similar of for and 12% stay HD hospital of shorter utilization a The has it reflux/gastritis postoperative Srsh ,PahnG,Pue ,Srsh ,Batca L hldcoudnsoyi the in Choledochoduodenostomy CL. Bhattachan R, Shrestha P, common Paudel and gallbladder GB, complicated Pradhan for S, Cholecystectomy LJ. Shrestha Koiza 5. C, Tsironis M, Dani treatment Y, surgical Argriov the for 4. techniques Various A. Blumgart’s Mehrabi In A, Ghafuri anastomosis. M, enteric to Esmaeilzadeh biliary A, companion and Shojaiefard exploration A 3. duct Bile surgery: CS. pancreatic Cho and SM, Ronnekleiv-Kelly Hepatobiliary 2. In: Gallstones. D. Menzies RW, Motson 1. aaeeto iae omnbl utdet hldcoihai.NplMdCl J.2012;14(1):31- Coll Med Nepal choledocholithiasis. to due duct bile 4 common dilated of management 2020.00042 Front.Surg management. ID surgical 2009;Article current practice stones: and duct Research biliary Gastroenterlogy metareview. A stones: duct 840208 bile (6 common set of pancreas,2-volune London and tract Ltd, biliary Company liver, Saunders the of WB surgery Publishers Garden. James O. ed 1997;p175-200. practice, surgical specialist 3 th dto)Cp 1 2017 31; Chpt edition) Posted on Authorea 5 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160193278.86359940/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. bile-duct-stone-managed-by-hepaticoduodenostomy-a-case-report Fig1.pdf file Hosted Failure hepaticoduodenostomy (1) of stones diagram duct Schematic bile 2: common Figure of management for strategies available the permission showing Algorithm 1: Figure Lci A cmd ,Tyo .Ipce omnbl utsoe.TeAeia Surgery J American The stones. duct bile common Impacted laparo- a R. during Taylor stones duct N, bile Schmidt common impacted PA, of Leckie Management G. 16. Junye Z, Chi Y, recommen- Yin EAES Z, al. Jinfeng et 15. A, acute Fingerhut HP, of Dauben A, management Cuschieri the GF, Buess for M, Becker Pathway EA, Neugebauer N. hepatico- 14. Maynard with treated G, syndrome Toogood Mirizzi IV C, Type Macutkiewicz G. I, Goes D, Beckingham Lima 13. GF, Abreu de Silva G, Carvalho hepaticojejunos- abdomen: 12. versus infected Hepaticoduodenostomy and RC. contaminated Cohen the KL, in Narasimhan drainage Y, of Chen role SK, The Narayanan drain? 11. to not or drain To M. Schein 10. SvnaehG aeV nnhkiha .Eauto fln-emrslso choledochoduodenos- of results long-term of Evaluation N. Ananthakrishnan (KUMJ) V, J Kate Med G, Univ con- Kathmadu Srvengadesh 130 cases. 9. consecutive 28 choledochoduodenostomy: of of study a assessment Current Choledochoduodenostomy: J. BS. H. Gupta Fujii bad? 8. J, so really Itakura it K, is Miura Choledochoduodenostomy: H, Okamoto KA. Morgan 7. DB, Adams TM, Shary WM, Leppard 6. cpcpoeue ersetv ootsuyo 7 osctv ains n ug 2016;32:1-5 Surg. J Int patients. consecutive 377 1982;143(5):540-541 of study cohort retrospective A procedure: scopic 2010;24:1594- Endosc. Surg surgery. endoscopic ar in online management innovation 615 Available of methodology on 2014;p1-12. dations Surgery Gastrointestinal Upper of 05/acute-Gallstones-pathway Association https:/www.augis.org/wp-content/uploads/2014/ diseases. gallstone e2016.00057 2013; CRSLS Surg minilaparoscopy. Pediatr by J duodenostomy meta-analysis. and review systematic a cyst: choledochal 48(111):2336-42 of resection 2008;32:312-321 after tomy Surg J World perspective. personal and international 2003;24(4):205-7 an Gastroenterol. Trop obstruction. biliary benign for tomy 2017;99(7):545-549 2004;2(3):193-7 Engl Surg Coll R Ann series. secutive 2011;15(5):754-7 Surg Gastrointestinal } vial at available Legend https://authorea.com/users/352246/articles/484639-impacted-common- 4 { with Posted on Authorea 5 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160193278.86359940/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 5