Endoscopy 2022; 54(06): E314-E315
DOI: 10.1055/a-1525-1824
E-Videos

An unusual cause of acute cholangitis

Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
,
Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
,
Hedi Benosman
Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
,
Hadrien Alric
Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
,
Christophe Cellier
Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
,
Gabriel Rahmi
Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, AP-HP Centre – Université de Paris, Paris
› Author Affiliations
 

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 % [1] [2] [3] 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 [4].

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) [5], hybrid enteroscopy-assisted ERCP was proposed for the patient.

Zoom Image
Fig. 1 Digestive radiological exam revealed a contiguous dilatation of the biliary loop to the biliary tree upstream of a 35-mm impacted stone. a Abdominal computed tomography scan. b Magnetic resonance cholangiopancreatography.

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.

Zoom Image
Fig. 2 Endoscopic view of a large biliary stone (30 mm) obstructing the whole digestive lumen. Of note, the stone was impacted on a relative non-ulcerated stenosis.

Video 1 An unusual cause of acute cholangitis.


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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Guillaume Perrod, MD
Gastroenterology and Digestive Endoscopy Department
Georges Pompidou European Hospital
AP-HP Centre – Université de Paris
20 Rue Leblanc
75015 Paris

Publication History

Article published online:
09 July 2021

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Zoom Image
Fig. 1 Digestive radiological exam revealed a contiguous dilatation of the biliary loop to the biliary tree upstream of a 35-mm impacted stone. a Abdominal computed tomography scan. b Magnetic resonance cholangiopancreatography.
Zoom Image
Fig. 2 Endoscopic view of a large biliary stone (30 mm) obstructing the whole digestive lumen. Of note, the stone was impacted on a relative non-ulcerated stenosis.