Abstract：
BACKGROUND: Postoperative cholangitis is a complication of biliary reconstruction during hepatobiliary pancreatic surgery. Most cases are associated with anastomotic stenosis, but there are also cases of cholangitis without stenosis, and treatment can be difficult, especially in patients with recurrent symptoms. In this report, we describe a case of repeated nonobstructive cholangitis in a patient after total pancreatectomy, in which a good outcome was obtained after performing tract conversion surgery.
METHODS: The patient was a 75-year-old man. He underwent total pancreatectomy for stage IIA cancer of the pancreatic body, hepaticojejunostomy via the posterior colonic route, gastrojejunostomy and Braun anastomosis via the anterior colonic route using the Billroth II method. The patient had a good postoperative course and was receiving adjuvant chemotherapy on an outpatient basis, but he developed his first episode of cholangitis 4 months after surgery. Although conservative treatment with antimicrobial agents was successful, the patient continued to have recurrent biliary cholangitis and was repeatedly admitted and discharged from the hospital. Since stenosis at the anastomosis was suspected, endoscopic observation of the anastomosis was performed using small bowel endoscopy for close examination, but no apparent stenosis was observed. Small bowel imaging indicated a possible influx of contrast medium into the bile duct, and reflux due to food residue was suspected as the cause of cholangitis. Since conservative treatment alone did not suppress the flare-up of symptoms, the decision was made to perform tract conversion surgery for curative purposes. The afferent loop was cut midstream, and jejunojejunostomy was performed downstream. The postoperative course was good, and the patient was discharged on the 10th day after surgery. He is currently an outpatient and has been free of cholangitis symptoms for 4 years without cancer recurrence.
CONCLUSIONS: Although the diagnosis of nonobstructive retrograde cholangitis can be difficult, surgical treatment should be considered in patients with recurrent symptoms and refractory treatment.
METHODS: The patient was a 75-year-old man. He underwent total pancreatectomy for stage IIA cancer of the pancreatic body, hepaticojejunostomy via the posterior colonic route, gastrojejunostomy and Braun anastomosis via the anterior colonic route using the Billroth II method. The patient had a good postoperative course and was receiving adjuvant chemotherapy on an outpatient basis, but he developed his first episode of cholangitis 4 months after surgery. Although conservative treatment with antimicrobial agents was successful, the patient continued to have recurrent biliary cholangitis and was repeatedly admitted and discharged from the hospital. Since stenosis at the anastomosis was suspected, endoscopic observation of the anastomosis was performed using small bowel endoscopy for close examination, but no apparent stenosis was observed. Small bowel imaging indicated a possible influx of contrast medium into the bile duct, and reflux due to food residue was suspected as the cause of cholangitis. Since conservative treatment alone did not suppress the flare-up of symptoms, the decision was made to perform tract conversion surgery for curative purposes. The afferent loop was cut midstream, and jejunojejunostomy was performed downstream. The postoperative course was good, and the patient was discharged on the 10th day after surgery. He is currently an outpatient and has been free of cholangitis symptoms for 4 years without cancer recurrence.
CONCLUSIONS: Although the diagnosis of nonobstructive retrograde cholangitis can be difficult, surgical treatment should be considered in patients with recurrent symptoms and refractory treatment.
摘要：
背景：术后胆管炎是肝胆胰腺手术中胆道重建的并发症。大多数病例与吻合口狭窄有关，但也有没有狭窄的胆管炎病例，治疗可能很困难，尤其是反复出现症状的患者。在这份报告中,我们描述了一例全胰腺切除术后患者反复出现的非阻塞性胆管炎，在进行尿道转换手术后获得了良好的结果。
方法：患者为75岁男性。他接受了胰腺体癌IIA期全胰腺切除术，通过后结肠途径进行肝空肠吻合术，使用BillrothII方法通过前结肠途径进行胃空肠吻合术和Braun吻合术。患者术后病程良好，正在接受门诊辅助化疗，但他在手术后4个月出现了第一次胆管炎。尽管使用抗菌药物的保守治疗是成功的，该患者继续患有复发性胆汁性胆管炎，并多次入院和出院。由于怀疑吻合口狭窄，使用小肠内镜进行吻合术的内镜观察，以进行密切检查，但未观察到明显狭窄。小肠成像显示造影剂可能流入胆管，食物残留物引起的回流被怀疑是胆管炎的原因。由于单独的保守治疗并不能抑制症状的发作，我们决定进行尿道转换手术以达到治愈目的.传入环路被切断，空肠空肠吻合术在下游进行。术后病程良好,患者在手术后第10天出院。他目前是一名门诊病人，4年来没有胆管炎症状，没有癌症复发。
结论：尽管非梗阻性逆行性胆管炎的诊断可能很困难，对于症状复发和难治性治疗的患者应考虑手术治疗。
方法：患者为75岁男性。他接受了胰腺体癌IIA期全胰腺切除术，通过后结肠途径进行肝空肠吻合术，使用BillrothII方法通过前结肠途径进行胃空肠吻合术和Braun吻合术。患者术后病程良好，正在接受门诊辅助化疗，但他在手术后4个月出现了第一次胆管炎。尽管使用抗菌药物的保守治疗是成功的，该患者继续患有复发性胆汁性胆管炎，并多次入院和出院。由于怀疑吻合口狭窄，使用小肠内镜进行吻合术的内镜观察，以进行密切检查，但未观察到明显狭窄。小肠成像显示造影剂可能流入胆管，食物残留物引起的回流被怀疑是胆管炎的原因。由于单独的保守治疗并不能抑制症状的发作，我们决定进行尿道转换手术以达到治愈目的.传入环路被切断，空肠空肠吻合术在下游进行。术后病程良好,患者在手术后第10天出院。他目前是一名门诊病人，4年来没有胆管炎症状，没有癌症复发。
结论：尽管非梗阻性逆行性胆管炎的诊断可能很困难，对于症状复发和难治性治疗的患者应考虑手术治疗。
