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An unusual cause of acute cholangitis
Endoscopic treatment can be challenging in patients presenting with biliary adverse events and a biliodigestive diversion. Multiples approaches have been described. In the past decade, an overall technical success of 80–86 %    of enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been described.
Herein, we report the original case of a 65-year-old patient with sickle cell disease who was referred to our department for an unusual acute cholangitis. The patient had undergone biliodigestive anastomosis and Roux-en-Y jejunal loop 25 years ago because of refractory macrolithiasis of the common bile duct. Of note, patients with sickle cell disease are prone to developing biliary adverse events .
The patient presented with fever and jaundice. The abdominal computed tomography (CT) scan confirmed the dilatation of the whole biliary tract and revealed a contiguous dilatation of the jejunal loop upstream of an impacted stone of 30 mm ([Fig. 1]). Once the absence of another cause of biliary obstruction was confirmed by magnetic resonance cholangiopancreatography (MRCP) , hybrid enteroscopy-assisted ERCP was proposed for the patient.
The enteroscopy was performed under general anesthesia, using a 3.2-mm working channel double-balloon enteroscope (EN-580T, Fujifilm, Tokyo, Japan). The push-and-pull technique was used to progress through the small bowel and the biliary loop was easily catheterized. Approximately 40 cm beyond the anastomosis, we identified a large biliary stone completely obstructing the lumen, impacted on a relative stenosis ([Fig. 2]). Lithotripsy was performed using 30-mm braided snare (Lariat; Life Partners Europe, Bagnolet, France) ([Video 1]). After multiple passes, the stone was completely broken up and the obstruction eliminated. The patient recovered well and was discharged 3 days later. The abdominal CT scan performed 1 month later confirmed the absence of residual stones.
Video 1 An unusual cause of acute cholangitis.
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Article published online:
09 July 2021
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