EUS-guided jejunoduodenostomy: another option for the management of stenosis in hepaticojejunoanastomosis

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically. EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.

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Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

Anatomy Research International ◽

10.1155/2012/838179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Theodoros Mariolis-Sapsakos ◽

Vasileios Kalles ◽

Konstantinos Papatheodorou ◽

Nikolaos Goutas ◽

Ioannis Papapanagiotou ◽

...

Keyword(s):

Bile Ducts ◽

Hepatic Duct ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Drainage Pattern ◽

Left Hepatic Duct ◽

Surgical Interventions ◽

Drainage Patterns ◽

The Common ◽

The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

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Treatment of late identified iatrogenic injuries of the right and left hepatic duct after laparoscopic cholecystectomy without transhepatic stent and Witzel drainage: Case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2018.05.008 ◽

2018 ◽

Vol 48 ◽

pp. 72-75 ◽

Cited By ~ 2

Author(s):

Zijah Rifatbegovic ◽

Maja Kovacevic ◽

Branka Nikic

Keyword(s):

Laparoscopic Cholecystectomy ◽

Case Report ◽

Hepatic Duct ◽

Left Hepatic Duct ◽

Iatrogenic Injuries ◽

The Right

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Using the stent-in-stent technique to drain the right hepatic duct, passing across a 7-year-old obstructed spiral self-expandable metal stent of the left hepatic duct

Gastroenterology Report ◽

10.1093/gastro/goaa019 ◽

2020 ◽

Author(s):

Ahmad Alhamid ◽

Ziad Aljarad ◽

Fayez Sandouk

Keyword(s):

Hepatic Duct ◽

Metal Stent ◽

Left Hepatic Duct ◽

The Right ◽

Self Expandable Metal Stent

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Hybrid Gastroenterostomy Using A Lumen-Apposing Metal Stent: A Case Report Focusing On Misdeployment.

10.21203/rs.3.rs-783524/v1 ◽

2021 ◽

Author(s):

Carlo Fabbri ◽

Cecilia Binda ◽

Paola Fugazzola ◽

Monica Sbrancia ◽

Matteo Tomasoni ◽

...

Keyword(s):

Case Report ◽

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Duodenal Bulb ◽

Outlet Obstruction ◽

Jejunal Loop ◽

Endoscopic Stenting ◽

Hybrid Technique ◽

Metal Stent ◽

Ultrasound Guided

Abstract BackgroundGastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Historically, surgical gastroenterostomy and enteral endoscopic stenting have represented effective therapeutic options. However, surgery is burdened by high complication and mortality rates, while endoscopic stenting demonstrates unsatisfactory patency after six months. Lately, endoscopic ultrasound-guided gastroenterostomy using lumen apposing metal stent (LAMS) is spreading in order to improve the outcome of this condition, but still complication rate remains not negligible. Our case report shows a hybrid (endoscopic and surgical) technique for LAMS deployment, reviews current literature on potential complications and demonstrates problem solving strategies. Case presentationA 60 year-old male patient, affected by metastatic pancreatic adenocarcinoma, developed gastric outlet obstruction due to a duodenal bulb stenosis. Endoscopic ultrasound-guided gastroenterostomy was performed in an operating room, but the first flange of LAMS was misdeployed opening in the epiploon retrocavity. Immediate diagnostic laparoscopy was carried out, LAMS was removed endoscopically and the first jejunal loop was identified by laparoscopy. The jejunal loop was placed near the stomach, allowing for endoscopic release of a second LAMS through the previous fistulous gastric tract, performing a laparoscopy-assisted gastroenterostomy.ConclusionsThis hybrid technique may offer an innovative strategy to overcome misdeployment of LAMS, which represents the most troubling complication of endoscopic ultrasound-guided approach. There are several significant advantages, such as the easy visualization of target loop and cystostome penetration, nevertheless the ability to considerably shorten overall procedure time.

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