Summary
The sump syndrome has been reported to occur infrequently following a choledochoenterostomy
(duodenostomy or jejunostomy) for stone disease. The enterostomy stoma usually decreases
in diameter following surgery allowing for reflux into the distal, inactive segment
of the bile duct without adequate egress of the material. This stagnant portion of
the bile duct functions as a reservoir for collection of debris and/or lithogenic
bile resulting in intermittent obstruction of the stoma producing symptoms of pain
and clinical and biochemical evidence of cholestasis and pancreatitis. This symptom
complex has been labelled as the sump syndrome and has been effectively diagnosed
by endoscopic retrograde cholangiopancreatography (ERCP) and treated by duodenoscopic
sphincterotomy. Occasionally the enterostomy stoma remains adequate but foreign material
or debris aggregates to produce obstruction. The case described in this report matched
the latter description and was diagnosed by a new endoscopic application, peroral
choledochoscopy. This new technique and the recommendations for evaluation and treatment
of the sump syndrome as well as alternate surgical techniques to avoid its occurrence
will be discussed.
Key words:
Sump syndrome - Biliary bezoar - Endoscopic removal
