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CT-scan showed the stones in remnant pancreatic cyst duct (arrow) and HJ anastomosis (arrowhead).
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The computed tomography (CT) scan (after 4 years since the first operation) showed a sign of common hepatic duct dilation and stones in the remnant pancreatic duct cyst (Fig. 1).
Balloon dilation in hepaticojejunal anastomosis stenosis.
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After excluding other causes of fever, the patient underwent balloon dilation (Fig. 2).
Biliary drainage in the second hospitalization (arrowhead: proximal drainage end).
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ALP and GGT was not further examined. A biliary drainage was taken by radiologist to reduce the severity of infection and the risk of post-op fistula as the team planned for the second operation (Fig. 3).
Minimal invasive surgery in stone removal (arrowhead) and redo HJ anastomosis.
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Thus, pancreatic cyst remnant with stone inside was also eliminated and clipped as well as new bilioenteric anastomosis was performed (Fig. 4).