Gallstone ileus after hepaticojejunostomy in liver transplant recipient: case report

Presenter: Patricio Vanerio MD | Hospital Central de las Fuerzas Armadas Background: Gallstone ileus is an infrequent cause of mechanical bowel obstruction. It caused by transition a gallstone in the gastrointestinal tract usually through biliary-enteric fistula, occurring 1 to 3% all cases In patients with hepaticojejunostomy gallstones can be formed at proximal side it and then pass lumen. this hepatolithiasis associated recurrent anastomotic stricture cholangitis. Even though abdomen computed tomography (CT) very informative for diagnosis ileus, oftenly found during laparotomy performed unexplained small We present case patient who was admitted whom stone (liver transplant recipient) entrapped afferent loop Roux-en-Y jejunojejunostomy. Methods: 22yo female. Heretopic reduced liver recipient 20 years ago because biliary atresia. Admitted 2 mild cholangitis, MRCP demonstrated stenosis hepatolithiasis. Treatment consisted percutaneous dilation bilioenteric anastomosis progression litiasis jejunum. No complications or symptoms were registered follow up next years. Begun sudden intermittent colicky abdominal pain, nausea, vomiting. Computed evidenced intestine hyperdense structures about 30 40mm as obstruction (figure). Mild intraabdominal fluid, no large dilation, other pathological findings. Exploratory performed, extensive adhesiolysis, roux en Y loop, A second distally. Enterotomy removal performed. Postoperative occurred without incidents. Patient discharged day 3. Results: Intestinal has many causes, secondary cholecystoduodenal fistula which corresponds abnormal communication between gallbladder duodenum that occurs rare complication untreated gallstones. Other hepatolihtiasis over pathologic cases, usual cholangitis infection bile duct. Percutaneous approach consists extraction and/or lithiasis, surgery more aggressive morbid re do. our advanced treatment before. Clinical radiological manifestations do not differ. Neither does surgical treatment, most common enterotomy indicated. Conclusion: extremely due recipient. treat stricture, however procedure progressed lithiasis distally into jejunal causing later.