Percutaneous transhepatic cholangioscopy using a flexible digital ureteroscope through A 10-FR vascular sheath: A novel method to evaluate bile duct injury in patients with Roux-en-Y gastric bypass surgery

摘要

Patients with long afferent limb Roux-en-Y gastric bypass (RYGB) surgery represent a subset of patients in whom endo-scopic management of bile duct pathology is challenging.We describe a 53-year-old woman with long afferent limb RYGB surgery for weight loss who presented with worsening abdominal pain 2 weeks after computed tomography (CT)-guided biopsy of pancreatic head fullness. An inadvertent common bile duct (CBD) injury resulting in bile duct leak was confirmed on nuclear scan. A subsequent percutaneous transhepatic cholangiogram (PTC) revealed moderate intra-hepatic and extrahepatic biliary duct dilatation with CBD stricture distal to the cystic duct (Fig. 1).