A Case of Bile Duct Stricture at the Anastomasis Site After Choledochoduodenostomy with Dysplasia

Hidetoshi Kanazawa, Keiko Kimura, Ken Hiei, Yuji Torimoto, Tomoki Ebata^*, Koji Oda^* and Junichi Kamiya^*

Department of Surgery, Mitsubishi Nagoya Hospital Division of Surgery Oncology, Department of Surgery, Nagoya University Graduate School of Medicine^*

Side-to-side anastomosis between the duodenum and bile duct conducted for choledocholithiasis may expose the biliary tract to reflux and stasis of duodenal contents including micro flora, food materials and activated pancreatic juice. Chronic mechanical and chemical irritation of the bile duct mucosa may thus result in inflammatory and/or dysplastic changes over a decade, which may be precursors of cancer. A 61-year-old man who had undergone choledochoduodenostomy 24 years earlier developed bile duct obstruction. We conducted extrahepatic bile duct resection and choledochojejunostomy to treat the biliary complication following side-to-side choledochoduodenostomy. The resected specimen showed hyperplastic and dysplastic changes in the biliary mucosa supporting the above view. Careful long-term follow-up is thus necessary in patients with side-to-side choledochoduodenostomy.

Key words
choledochoduodenostomy, dysplasia

Reprint requests
Hidetoshi Kanazawa Division of Surgery Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Turumaichou, Shouwaku, Nagoya 466-8550 JAPAN

Accepted
December 12, 2001

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