A CASE OF BENIGN BILE DUCT STRICTURE IN WHICH A PLACED METALLIC STENT COULD BE REMOVED

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  • 留置メタリックステントが抜去可能であった良性胆管狭窄の１例

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A 60-year-old man who underwent distal gastrectomy with Billroth I reconstruction for gastric cancer developed acute cholangitis and obstructive jaundice one month after the operation. Following close exploration, benign stricture of the common bile duct was diagnosed. We tried in vain to relieve obstructive jaundice by performing percutaneous transhepatic cholangiodrainage (PTCD) as well as to perform percutaneous transhepatic balloon dilatation. Accordingly an expandable metallic stent (EMS) was placed 2 months after the development of jaundice. Dramatic symptomatic remission was attained with this procedure and external biliary tubes were able to be removed one month after the placement of the EMS. The patient was discharged very much improved. The patient, however, was re-admitted to the hospital because of obstructive jaundice developed 2 years 9 months after the EMS placement, when the common bile duct had been filled with stones. Percutaneous transhepatic cholangioscopy (PTCS) was performed while lavage of the bile duct was done by PTCD for obstructive jaundice. Because stones clung to the stent were confirmed, the stones were broken by biopsy forceps, washed out, and absorbed. These operations were repeated until a part of the threads of the stent began to be loose, when wires were pulled out one by one by using forceps and the EMS was eventually removed. Thereafter stricture of the common bile duct had not recurred and external biliary tubes were removed. The patient was discharged very much improved.

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