Phytobezoar des Ductus hepaticus communis – seltene Differenzialdiagnose einer Cholestase im Langzeitverlauf nach Kausch-Whipple-Operation: Fallbericht und Literaturübersicht

Zusammenfassung

Ursache für eine Galleabflussstörung nach kephaler Pankreatoduodenektomie können Strikturen der im Rahmen der Operation angelegten Hepaticojejunostomie, Passagestörungen im Bereich der anastomosierten Jejunalschlinge, Konkremente oder sehr selten ingestierte Fremdkörper im Ductus hepaticus sein. Die aufgehobene Funktion des Sphincter Oddi nach Anlage einer Hepaticojejunostomie kann – ebenso wie nach endoskopischer Papillotomie oder der früher häufig praktizierten Anlage einer Seit-zu-Seit-Choledochoduodenostomie – zum Auftreten eines enterobiliären Refluxes führen, was die Migration oral aufgenommener Fremdkörper oder faseriger Nahrungsbestandteile in den Gallengang begünstigt. Ausgehend von der Schilderung eines derartigen Falles wird eine Übersicht der verfügbaren Literatur über das seltene Phänomen des fremdkörperinduzierten mechanischen Ikterus gegeben.

Abstract

Obstruction of bile flow following pancreatoduodenectomy can be caused by stenosis of the hepaticojejunostomy created at the time of surgery, obstruction of the bile-draining jejunal loop, stones or, very rarely, ingested foreign bodies in the common hepatic duct. In analogy with endoscopic sphincterotomy or the once popular side-to-side-choledochduodenostomy, the creation of a hepaticojejunostomy eliminates the barrier of the sphincter Oddi, enabling intestinal content such as ingested foreign bodies or food fibers to migrate into the bile duct. We report on the case of a patient developing biliary tract obstruction due to fibrous material in the common hepatic duct 15 years after pancreatoduodenectomy. In addition, an overview of the literature on the rare phenomenon of foreign body-associated obstructive jaundice is given.

Schlüsselwörter

Cholestase - Fremdkörper - Ductus hepaticus communis - Pankreatoduodenektomie

Key words

cholestasis - foreign body - common hepatic duct - pancreatoduodenectomy

¹ F. Meyer und H. Lippert haben zu gleichen Anteilen an dem Manuskript mitgearbeitet.

• Literatur

• 1 Bachmann K, Kutup A, Mann O et al. Surgical treatment in chronic pancreatitis timing and type of procedure. Best Pract Res Clin Gastroenterol 2010; 24: 299-310
• 2 Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2007; 6: 121-133
• 3 House MG, Cameron JL, Schulick RD et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 571-576
• 4 Reid-Lombardo KM, La Ramos-De Medina A, Thomsen K et al. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 2007; 11: 1704-1711
• 5 Pedrazzoli S, Canton SA, Sperti C. Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions. J Hepatobiliary Pancreat Sci 2011; 18: 94-102
• 6 Yamaguchi K, Tanaka M, Chijiiwa K et al. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg 1999; 6: 303-311
• 7 Pannala R, Brandabur JJ, Gan S et al. Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience. Gastrointest Endosc 2011; 74: 295-302
• 8 Chong VH, Chong CF. Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases. J Gastrointest Surg 2010; 14: 688-696
• 9 Das K, Basu K, Ray S et al. Suture material in the common bile duct causing recurrent post-cholecystectomy pain. Endoscopy 2010; 42 (Suppl. 02) E258
• 10 Gonzalez FJ, Dominguez E, Lede A et al. Migration of vessel clip into the common bile duct and late formation of choledocholithiasis after laparoscopic cholecystectomy. Am J Surg 2011; 202: e41-e43
• 11 Lee SL, Kim H, Cho Y. Acute obstructive cholangitis due to foreign body in the common bile duct. Migrated endoclip. Gastroenterology 2010; 139: e3-e4
• 12 Walker WE, Avant GR, Reynolds VH. Cholangitis with a silver lining. Arch Surg 1979; 114: 214-215
• 13 Raoul JL, Bretagne JF, Siproudhis L et al. Cystic duct clip migration into the common bile duct: a complication of laparoscopic cholecystectomy treated by endoscopic biliary sphincterotomy. Gastrointest Endosc 1992; 38: 608-611
• 14 Onghena T, Vereecken L, van den Dwey K et al. Common bile duct foreign body: an unusual case. Surg Laparosc Endosc 1992; 2: 8-10
• 15 Bhandari V, Singh M, Vyas HG et al. Diagnostic dilemma in an unusual case of common bile duct obstruction. Gut Liver 2011; 5: 245-247
• 16 Hussain SMA, Zulqurnain S, Saleem O. Delayed obstructive jaundice secondary to bullet in common hepatic duct. J Coll Physicians Surg Pak 2007; 17: 232-233
• 17 Kamona A, Mansour A, Qandeel M et al. Biliary obstruction secondary to combat-related foreign bodies: report of two cases. Abdom Imaging 2005; 30: 748-749
• 18 Silverman WB. Sclerosing cholangitis caused by old shrapnel injury. Gastrointest Endosc 2003; 58: 420
• 19 Somi MH, Rezaeifar P. Shrapnel splinter in the common bile duct. Arch Iran Med 2010; 13: 53-56
• 20 Teicher EJ, Sandhu RS, Dangleben DA et al. Common duct obstruction by shotgun bullet fragment as a cause of cholangitis. Am Surg 2010; 76: 780-782
• 21 Ban JL, Hirose FM, Benfield JR. Foreign bodies of the biliary tract: report of two patients and a review of the literature. Ann Surg 1972; 176: 102-107
• 22 Cetta F, Lombardo F, Rossi S. Large foreign body as a nidus for a common duct stone in a patient without spontaneous biliary enteric fistula or previous abdominal surgery. HPB Surg 1993; 6: 235-242
• 23 David X, Bories P, Parelon G et al. Acute pancreatitis induced by “herbs of Provence”. Lancet 1991; 337: 311
• 24 Kelly MD, Hugh TB. Cherry stalk in the common bile duct. Aust N Z J Surg 1993; 63: 571-574
• 25 Kim TO, Lee SH, Kim GH et al. Common bile duct stone caused by a phytobezoar. Gastrointest. Endosc 2006; 63: 324 ; discussion 324
• 26 Kutlik IE. Tomato peelings as a cause of choledocholithiasis. Gastroenterologia 1961; 95: 382-391
• 27 Leman G, Lorré A, Nelis P et al. Common bile duct stone caused by a foreign body: a case report and literature review. Acta Chir Belg 1990; 90: 163-165
• 28 Meltzer SJ, Goldberg MD. Recurrent pancreatitis caused by vegetable matter obstruction. Am J Gastroenterol 1986; 81: 1091-1092
• 29 Procházka V, Krausová D, Kodousek R et al. Foreign material as a cause of choledocholithiasis. Endoscopy 1999; 31: 383-385
• 30 Choojai S. Jujube in common bile duct. Lancet 1968; 291 (7541) 530-531
• 31 Szántó I, Gamal EM, Banai J et al. Common bile duct stone formation induced by tomato skin following endoscopic sphincterotomy. Endoscopy 1994; 26: 712
• 32 Vitovec J. Phytobezoar des Ductus choledochus. Fortschr Röntgenstr 1975; 123: 593-594
• 33 Kaji H, Asano N, Tamura H et al. Common bile duct stone caused by a fish bone: report of a case. Surg Today 2004; 34: 268-271
• 34 Kim YH, Kim YJ, Park WK et al. Fish bone as a nidus for stone formation in the common bile duct: report of two cases. Korean J Radiol 2004; 5: 210-213
• 35 Orda R, Leviav A, Ratan I et al. Common bile duct stone caused by a foreign body. J Clin Gastroenterol 1986; 8: 466-468
• 36 Sakai T, Kihara M, Wagayama H et al. A case of recurrent choledocholithiasis due to foreign bodies (fish bones) after endoscopic sphincterotomy. Nihon Shokakibyo Gakkai Zasshi 1997; 94: 143-147
• 37 Baldota S, Breach C, Murtuza B et al. Chicken bone injury of the common bile duct. J R Soc Med 2000; 93: 84
• 38 Losanoff JE, Kjossev KT. Chicken bone in the common bile duct. J Clin Gastroenterol 2001; 32: 463
• 39 Dias R, Dharmaratne P. Ingested foreign body in the common bile duct. J Indian Assoc Pediatr Surg 2012; 17: 31-32
• 40 Sun S, Wu S, Cui D et al. Sphincter of Oddi manometry by choledochoscope in patients with duodenobiliary reflux. J Gastroenterol Hepatol 2011; 26: 1252-1255
• 41 Tomita R, Tanjoh K. Endoscopic manometry of the sphincter of Oddi in patients with Lemmel's syndrome. Surg Today 1998; 28: 258-261
• 42 Siegel JH. Biliary Bezoar: the sump syndrome and choledochoenterostomy. Endoscopy 1982; 14: 238-240