Article: Enterolith formation in the roux limb hepaticojejunostomy

Enterolith in the Roux limb of Roux-en-Y hepaticojejunostomy is rare. We report a case of a Roux loop enterolith presenting with recurrent cholangitis. Cholescintigraphy and magnetic resonance imaging aided in the preoperative diagnosis. Intraoperatively, a large enterolith was extracted distal to the biliodigestive anastomosis. A kink of the small bowel was also noted distal to the stone. The mechanism for enterolith formation in the Roux loop is discussed.

Citing Articles

Gallstone ileus 30 years after cholecystectomy and hepaticojejunostomy.

Todd C, Wong R, Covin B, Keith S BMJ Case Rep. 2023; 16(12).

PMID: 38087485 PMC: 10728934. DOI: 10.1136/bcr-2023-258398.

Migrated Pancreaticojejunal Stent Forming a Stent-Stone Complex in the Jejunum with Resultant Small Bowel Obstruction: A Case Report.

Kim J, Kim Y, Lee B J Korean Soc Radiol. 2023; 84(2):512-517.

PMID: 37051393 PMC: 10083637. DOI: 10.3348/jksr.2022.0102.

Enterolith Treated with a Combination of Double-Balloon Endoscopy and Cola Dissolution Therapy.

Nomura K, Shibuya T, Omori M, Odakura R, Ito K, Maruyama T Medicina (Kaunas). 2023; 59(3).

PMID: 36984574 PMC: 10051240. DOI: 10.3390/medicina59030573.

Enterolith in Roux limb causing extrahepatic biliary obstruction in a patient with a hepaticojejunostomy: case report and relevant literature review.

Kumar V, Mulpuri V, Gupta P, Gupta V BMJ Case Rep. 2022; 15(3).

PMID: 35236682 PMC: 8895898. DOI: 10.1136/bcr-2021-246935.

Nontraumatic perforation of the small intestine caused by true primary enteroliths associated with radiation enteritis: a case report.

Hirakawa Y, Shigyo H, Katagiri Y, Hashimoto K, Katsumoto M, Tomoeda H Surg Case Rep. 2021; 7(1):102.

PMID: 33891220 PMC: 8065084. DOI: 10.1186/s40792-021-01182-y.

References

1.

Geroulakos G, Taylor W, Smithers B, Wilkins J . Multiple enteroliths in a chronically obstructed duodenal loop after Roux-en-Y biliary diversion. Surgery. 1987; 102(5):883-5. View

2.

Hashimoto N, Kotoura Y, Ohyanag H . Hepatobiliary scintigraphy after biliary reconstruction-Roux Y and RY-DJ. Hepatogastroenterology. 2005; 52(61):200-2. View

3.

Conter R, Converse J, McGarrity T, Koch K . Afferent loop obstruction presenting as acute pancreatitis and pseudocyst: case reports and review of the literature. Surgery. 1990; 108(1):22-7. View

4.

Le Blanc-Louvry I, Ducrotte P, Manouvrier J, Peillon C, Testart J, Denis P . Motility of the Roux-en-Y hepaticojejunostomy in asymptomatic patients. Am J Gastroenterol. 1999; 94(9):2501-8. DOI: 10.1111/j.1572-0241.1999.01384.x. View

5.

Hashimoto N, Ohyanagi H . Hepatobiliary scintigraphy after biliary reconstruction--a comparative study on Roux-Y and ESCD. Hepatogastroenterology. 2000; 47(35):1210-2. View

6.

Matthews J, Baer H, Schweizer W, Gertsch P, Carrel T, Blumgart L . Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass. Arch Surg. 1993; 128(3):269-72. DOI: 10.1001/archsurg.1993.01420150023004. View

7.

De Moor V, El Nakadi I, Jeanmart J, Gelin M, Donckier V . Cholangitis caused by Roux-en-Y hepaticojejunostomy obstruction by a biliary stone after liver transplantation. Transplantation. 2003; 75(3):416-8. DOI: 10.1097/01.TP.0000044701.46034.C6. View

8.

Sartori N, Falconi M, Contro C, Bassi C, Pederzoli P . Symptomatic stone in the duodenum after gastrectomy. Surgery. 2001; 129(2):238-9. DOI: 10.1067/msy.2001.104534. View

9.

van der Mijle H, Kleibeuker J, Limburg A, Bleichrodt R, BEEKHUIS H, Van Schilfgaarde R . Manometric and scintigraphic studies of the relation between motility disturbances in the Roux limb and the Roux-en-Y syndrome. Am J Surg. 1993; 166(1):11-7. DOI: 10.1016/s0002-9610(05)80574-4. View

10.

Ducrotte P, Peillon C, Guillemot F, Testart J, Denis P . Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies? A manometric study. Am J Gastroenterol. 1991; 86(9):1255-8. View

11.

Aigner R, FUEGER G, Schimpl G, Sauer H, Nicoletti R . Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts. Pediatr Radiol. 1998; 27(11):850-4. DOI: 10.1007/s002470050253. View

Enterolith Formation in the Roux Limb Hepaticojejunostomy