PMC6742713_01
Computerized axial tomographic scan showing the original choledochojejunostomy (arrow).
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F1
By examining the CT image, we could see the original choledochojejunostomy (Figure 1), the "whirl" of the mesenteric artery and vein (Figure 2), the stone of the common bile duct (Figure 3), and the thickening and bubble of the small intestine wall (Figure 4).
Computerized axial tomographic scan showing the "whirl" of the mesenteric artery and vein (arrow).
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F2
By examining the CT image, we could see the original choledochojejunostomy (Figure 1), the "whirl" of the mesenteric artery and vein (Figure 2), the stone of the common bile duct (Figure 3), and the thickening and bubble of the small intestine wall (Figure 4).
Computerized axial tomographic scan showing the stone of the common bile duct (arrow).
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F3
By examining the CT image, we could see the original choledochojejunostomy (Figure 1), the "whirl" of the mesenteric artery and vein (Figure 2), the stone of the common bile duct (Figure 3), and the thickening and bubble of the small intestine wall (Figure 4).
Computerized axial tomographic scan showing the thickening (arrowhead) and bubble (arrow) of the small intestine wall.
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F4
By examining the CT image, we could see the original choledochojejunostomy (Figure 1), the "whirl" of the mesenteric artery and vein (Figure 2), the stone of the common bile duct (Figure 3), and the thickening and bubble of the small intestine wall (Figure 4).
Necrotic, blackened, and not peristaltic intestine canal.
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F5
After separating the adhesive cord band, we reduced the torsion of the intestinal tube, which revealed that the output intestinal loop above the ileocecal junction 5 cm and below the choledochojejunostomy 25 cm was necrotic, blackened, not peristaltic, had edema, and there was exudation of the intestinal wall (Figure 5), over a length of ~2.6 m.
Jejunum of interposition of the original choledochojejunostomy.
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F6
In view of the short residual small intestine, we fully dissociated the anti-adverse peristaltic loop of the original choledochojejunostomy in order to avoid a USBS, after which we observed the jejunum of interposition about the length of 25 cm (Figure 6).
Jejunum of interposition anastomosed between the remnant jejunum and ileocecal junction.
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F7
Therefore, we dissected the intestine canal ~1 cm below the original choledochojejunostomy and anastomosed it between the remnant jejunum and the ileocecal junction (Figure 7); Varus anastomosis was performed on the anterior and posterior intestinal walls and the muscular layer was strengthened.
Side-to-side anastomosis of the bile duct and duodenum.
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F8
To reduce the impact of surgical trauma on the body, we decided to perform side-to-side anastomosis of the bile duct and duodenum (Figure 8).