A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y reconstruction at 42 years of age for intrahepatic stones and liver abscesses. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed bile duct stones and intrahepatic bile duct dilation of the caudate lobe. Bile duct drainage for the caudate lobe was necessary; however, the volume of his caudate lobe was very small, making percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD) difficult. Therefore, we attempted laparotomy-assisted endoscopic biliary drainage. Under general anesthesia, an incision was made on the jejunum approximately 15 cm from the Y-leg anastomosis. An esophagogastroduodenoscope was directly inserted into the common hepatic duct anastomosed with the jejunum. The caudate lobe branch had severe stenosis, and the area upstream of the stenosis was filled with stones, sludge, and pus. The biliary stenosis was dilated using a balloon, and the stones were completely removed using a basket and a balloon catheter. There are various methods of biliary and pancreatic surgery and gastrointestinal reconstruction, and there are cases in which PTBD, EUS-BD, and endoscopic retrograde cholangiopancreatography (ERCP) with an enteroscope are difficult. In such cases, ERCP under laparotomy could be a good treatment option.
Case Rep Gastroenterol 2021;15:674–679

中文翻译：

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开腹辅助直接胆管镜通过空肠切口去除胆管结石

一名 77 岁男性因上腹痛就诊于我院。他曾在 42 岁时因肝内结石和肝脓肿接受过肝左外侧段切除术、胆管空肠吻合术和 Roux-en-Y 重建术。腹部计算机断层扫描和磁共振胰胆管造影显示胆管结石和尾状叶肝内胆管扩张。尾状叶胆管引流是必要的；然而，他的尾状叶体积非常小，使得经皮经肝胆道引流术 (PTBD) 或内镜超声引导胆道引流术 (EUS-BD) 变得困难。因此，我们尝试了剖腹手术辅助内镜胆道引流术。在全身麻醉下，在距 Y 腿吻合口约 15 厘米的空肠上做一个切口。食管胃十二指肠镜直接插入与空肠吻合的肝总管。尾状叶分支狭窄严重，狭窄上游区域充满结石、淤泥和脓液。使用球囊扩张胆道狭窄，使用篮子和球囊导管完全取出结石。胆胰外科手术和胃肠重建术的方法多种多样，PTBD、EUS-BD、内窥镜逆行胰胆管造影（ERCP）也有困难的情况。在这种情况下，剖腹手术下的 ERCP 可能是一个很好的治疗选择。和脓。使用球囊扩张胆道狭窄，使用篮子和球囊导管完全取出结石。胆胰外科手术和胃肠重建术的方法多种多样，PTBD、EUS-BD、内窥镜逆行胰胆管造影（ERCP）也有困难的情况。在这种情况下，剖腹手术下的 ERCP 可能是一个很好的治疗选择。和脓。使用球囊扩张胆道狭窄，使用篮子和球囊导管完全取出结石。胆胰手术和胃肠重建的方法有多种，PTBD、EUS-BD、内窥镜逆行胰胆管造影（ERCP）也有困难的情况。在这种情况下，剖腹手术下的 ERCP 可能是一个很好的治疗选择。
Case Rep Gastroenterol 2021；15:674–679