TÇCD 2013 31st Annual Congress of Turkish Pediatric Surgical Association

Aim: One of the serious complications on long-term follow-up of the hepaticojejunostomy is intra or extrahepatic bile duct stone formation. We report that two cases were treated by percutaneous transhepatic treatment of common hepatic duct and intrahepatic bile duct stones developed after hepaticojejunostomy for choledochal cysts.

Case #1: A 26-years-old man patient who was operated for type 1 choledochal cyst when he was 6 years-old was investigated due to recurrent cholangitis. It was determined that was a large stone, was cone shaped and 5x1.5 cm in size, was at the common hepatic duct and partially obstructing the bile flow.

Case #2: A 14-years-old girl patient who was operated for type 1 choledochal cyst when she was 10 years-old was investigated due to recurrent cholangitis. presented with common hepatic duct stones plus intrahepatic bile duct stones. It was determined that multiple stones had had in the intrahepatic bile duct.

Percutaneous Transhepatic cholangiography was performed to each patient. In the two patients, it was determined that hepatico-jejunal anastomosis line was narrow and there were a lot of stones inducing from partial obstruction in the bile ducts. The common hepatic duct stones was pushed into the jejunum after dilating the hepatic duct-jejunal junction with a balloon by percutaneous transhepatic route. The catheter was introduced through the periphery of the left main hepatic duct. Afterwards all the peripheral and central placed stones were pushed into the jejunum using the same route and technique. A temporary biliary stent was left to ensure bile flow after the procedure. The patient recovered uneventfully and he is following up periodically

Conclusion: Percutaneous transhepatic treatment of common bile duct and intrahepatic bile duct stones that seen afterwards hepatico-jejustomy for choledochal cysts  is a safety and effectively method.

Amaç: Koledok kistlerinin tedavisinde uygulanan kist eksizyonu ve hepatiko-jejunostominin uzun dönem ciddi komplikasyonlarından biri safra kanallarında taş oluşmasıdır. Koledok kisti nedeniyle hepatiko-jejunostomi yapılan 2 hastada gelişen safra kanalı taşlarına uygulanan perkütan transhepatik tedavi deneyimlerimizi sunmak istiyoruz.

Olgu 1: Tip 1 koledok kisti tanısı ile 6 yaşında ameliyat edilmiş olan 26 yaşında erkek hasta tekrarlayan kolanjit atakları nedeniyle incelendi. İntrahepatik safra kanalları içerisinde çok sayıda taşlar ve hepatiko-jejunostomi anostomoz hattında ise koni şekilli (5 x 1,5 cm boyutunda) büyük bir taş saptandı.

Olgu 2: 10 yaşında Tip 1 koledok kisti nedeniyle ameliyat edilmiş olan 14 yaşındaki kız hasta tekrarlayan kolanjit atakları nedeniyle incelendi. İntrahepatik safra kanallarında çok sayıda taş saptandı.

Hastalara perkütan transhepatik kolanjiografi yapıldı. Her iki hastada hepatiko-jejunal anostomoz hattında darlık olduğu ve parsiyel obstrüksiyona sekonder gelişen çok sayıda taş safra kanalları içerisinde saptandı. Perkutan transhepatik ilerletilen bir balon kateter ile anostomoz darlığı dilate edildikten sonra taşlar jejunuma itildi. Sol ana hepatik safra kanalı yoluyla transanostomotik geçici stent yerleştirildi. Takipleri sorunsuz seyreden hastaların stentleri çekildi ve hiç biri işlem sonrası kolanjit atağı geçirmedi.

 Sonuç: Koledok kistlerinde hepatiko-jejunostomi sonrası görülen safra kanalı taşlarının tedavisinde perkütan transhepatik yöntemle balon ile dilatasyon ve taşların jejunuma itilmesi güvenli ve etkili bir yöntemdir.