Subcutaneous bling loop--a new type of hepaticocholedochojejunostomy for bilateral intrahepatic calculi
Kan, F.; Tsung-chih, C.
Chinese Medical Journal 3(6): 413-418
1977
ISSN/ISBN: 0366-6999 PMID: 414897 Document Number: 123150
An unusual case of bilateral hepatic calculi was discovered. After removal of the calculi from the main branches of the intrahepatic ducts, a side-to-end Roux-Y anastomosis of the common hepatic and bile ducts and jejunum was made. But suppurative cholangitis of the left hepatic duct, multiple abscesses in the left lateral liver lobe, gram negative bacilli septicemia and septic shock occurred postoperatively. The patient recovered after an emergency left liver lobectomy, but the wound was infected and an everting intestinal fistula formed because of pressure necrosis of the distal jejunal loop caused by the steel wire sutures. Calculi frequently exuded from the fistula with leaked bile. After the intestinal fistula was repaired to prevent constant loss of bile, repeated attacks of intrahepatic biliay obstruction and cholangitis occurred often accompanied by mild jaundice. An improved short subcutaneous blind loop type of hepaticocholedochojejunostomy (Roux-Y or Brown Type) was designed to treat bilateral intrahepatic calculi.