PMC6122482_01
CT shows a dilated left intra-hepatic duct containing a stone or debris (A, white arrow), and a dilated right intra-hepatic duct with a stone or debris (B, white arrow). US displays a right intra-hepatic duct filled with debris (C, thin arrows).
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Abdominal computed tomography (CT) revealed dilation of intrahepatic bile ducts in the lower left lobe and posterior right lobe, with bile duct stones and/or debris also being visible (Fig. 1A, B). Abdominal ultrasonography (US) also showed that the right hepatic duct was filled with debris (Fig. 1C).
Cholangiography shows stricture of the hepaticojejunostomy anastomosis (A, long arrow). There is a fistula from the jejunal limb to the duodenum (A, B, red arrow) at the right duodenal wall (A, B, short arrow). Duodenal endoscopy reveals the duodeno-jejunal fistula (C, arrow).
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Cholangiography via the PTBD tube showed a hilar hepatic duct stricture (Fig. 2A, long white arrow) and stones in the left intrahepatic bile duct. It also revealed a fistula between the reconstructed jejunal limb and the duodenum (Fig. 2 A, B, red arrow). Duodenal endoscopy directly revealed the fistula communicating with the reconstructed jejunal limb (Fig. 2C).
Schematic illustration of hepatic ductoplasty. The anterior wall of the hepatic duct is incised longitudinally and everted towards the liver parenchyma (A). Illustration of stricture-plasty (B). Wide and broad H-J anastomosis of postoperative cholangiography (C, arrow).
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Fig. 3. First, the previous biliary-enteric anastomosis was resected and the anterior wall of the stenotic shortened hepatic duct was longitudinally incised near the liver parenchyma. Briefly, the anteriorly incised hepatic duct was everted toward the liver parenchyma to make a wide stoma (Fig. 3A). In addition, stricture-plasty of the left intra-hepatic duct orifice was performed to relieve biliary stasis, as shown in Fig. 3B. Postoperative cholangiography apparently showed wide and broad H-J anastomosis in Fig. 3C.