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Heterotaxy syndrome and biliodigestive anastomosis with migration of biliar prosthesis


Gastroenterology & Hepatology: Open Access
José Maximiliano Garófano-Jerez,1,2,3 Elena Benedicto-Hernández,4 Juan de Dios López-González Gila,5 Antonio Paulino Garófano-Jerez,6 Juan de Dios López-González Garrido1,2

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Abstract

Background Endoscopic stent insertion is a primary technique for the decompression of obstructed biliopancreatic duct system. Distal migration of biliary stents is considered a rare complication. When this happens, prostheses normally pass spontaneously through the gastrointestinal tract or remain in the intestine without symptoms, but sometimes the migration of the stent can lead to impaction and cause problems. A biliodigestive anastomosis is a surgical connection between the common bile duct and the digestive tract to prevent interference of bile flow. This surgery may be performed for several different reasons, including management of the injury of the biliary tract. Roux-en-Y hepaticojejunostomy is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. Heterotaxy is a rare syndrome characterized by an abnormal arrangement of the internal organs in the chest and abdomen. Despite its variable presentation, heterotaxy syndrome can be classified into heterotaxy with polysplenia or left isomerism, and heterotaxy with asplenia or right isomerism. Case presentation We present the case of a 42-year-old male with heterotaxy with polysplenia who underwent laparoscopic cholecystectomy for cholelithiasis. The reconstruction of the bile duct was performed as a result of the complete section of the common hepatic duct during surgery. The next six years, he presented with recurrent episodes of cholangitis that required dilation of the stenosis and the placement of biliary stents through ERCP. However, the patient required a Roux-en-Y biliodigestive anastomosis during which distal migration of the biliary stent occurred, The prosthesis remained in the duodenum for several months without showing clinical symptoms, until it was removed by endoscopy using a polypectomy handle. Conclusion This is a unique case in the literature for heterotaxy and the patient's surgical history, in which distal migration of the biliary stent occurs during surgical manipulation in the biliodigestive shunt. The jejunojejunal anastomosis is an area where the stent can easily be stopped.

Keywords

Biliary tract, stents, foreign-body migration, anastomosis Roux-en-Y, heterotaxy syndrome, polysplenia syndrome

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