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Z Gastroenterol 2012; 50(11): 1166-1170
DOI: 10.1055/s-0032-1313178
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© Georg Thieme Verlag KG Stuttgart · New York

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

Phytobezoar in the Common Hepatic Duct – Rare Cause of Obstructive Jaundice Following Pancreatoduodenectomy: Case Report and Review of the Literature
B. Garlipp
1   Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
,
H.-U. Schulz
1   Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
,
S. Böttcher
2   Institut für Pathologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
,
A. Lemke
2   Institut für Pathologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
,
F. Meyer
1   Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
,
H. Lippert
1   Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg
› Author Affiliations
Further Information

Publication History

12 April 2012

29 July 2012

Publication Date:
13 November 2012 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 2 Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2007; 6: 121-133
    PubMedGoogle Scholar
  • 3 House MG, Cameron JL, Schulick RD et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 571-576
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 12 Walker WE, Avant GR, Reynolds VH. Cholangitis with a silver lining. Arch Surg 1979; 114: 214-215
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Silverman WB. Sclerosing cholangitis caused by old shrapnel injury. Gastrointest Endosc 2003; 58: 420
    CrossrefPubMedGoogle Scholar
  • 19 Somi MH, Rezaeifar P. Shrapnel splinter in the common bile duct. Arch Iran Med 2010; 13: 53-56
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 David X, Bories P, Parelon G et al. Acute pancreatitis induced by “herbs of Provence”. Lancet 1991; 337: 311
    PubMedGoogle Scholar
  • 24 Kelly MD, Hugh TB. Cherry stalk in the common bile duct. Aust N Z J Surg 1993; 63: 571-574
    CrossrefPubMedGoogle Scholar
  • 25 Kim TO, Lee SH, Kim GH et al. Common bile duct stone caused by a phytobezoar. Gastrointest. Endosc 2006; 63: 324 ; discussion 324
    CrossrefPubMedGoogle Scholar
  • 26 Kutlik IE. Tomato peelings as a cause of choledocholithiasis. Gastroenterologia 1961; 95: 382-391
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 28 Meltzer SJ, Goldberg MD. Recurrent pancreatitis caused by vegetable matter obstruction. Am J Gastroenterol 1986; 81: 1091-1092
    PubMedGoogle Scholar
  • 29 Procházka V, Krausová D, Kodousek R et al. Foreign material as a cause of choledocholithiasis. Endoscopy 1999; 31: 383-385
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Choojai S. Jujube in common bile duct. Lancet 1968; 291 (7541) 530-531
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Vitovec J. Phytobezoar des Ductus choledochus. Fortschr Röntgenstr 1975; 123: 593-594
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 37 Baldota S, Breach C, Murtuza B et al. Chicken bone injury of the common bile duct. J R Soc Med 2000; 93: 84
    PubMedGoogle Scholar
  • 38 Losanoff JE, Kjossev KT. Chicken bone in the common bile duct. J Clin Gastroenterol 2001; 32: 463
    PubMedGoogle Scholar
  • 39 Dias R, Dharmaratne P. Ingested foreign body in the common bile duct. J Indian Assoc Pediatr Surg 2012; 17: 31-32
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 41 Tomita R, Tanjoh K. Endoscopic manometry of the sphincter of Oddi in patients with Lemmel's syndrome. Surg Today 1998; 28: 258-261
    CrossrefPubMedGoogle Scholar
  • 42 Siegel JH. Biliary Bezoar: the sump syndrome and choledochoenterostomy. Endoscopy 1982; 14: 238-240
    Article in Thieme ConnectPubMedGoogle Scholar