Non-cirrhotic portal hypertension secondary to cholangiointestinal anastomotic stricture after choledochal cyst excision: a case report

Frontiers in Medicine

Medicine

Xu Zhang¹  Jun Qing Yan¹  Yan Ying Gao¹  De Zhao Song²  Cheng Lou³ 

[1] Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China;Artificial Cell Engineering Technology Research Center, Tianjin, China;Tianjin Institute of Hepatobiliary Disease, Tianjin, China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China;Artificial Cell Engineering Technology Research Center, Tianjin, China;Tianjin Institute of Hepatobiliary Disease, Tianjin, China;Department of Interventional Radiology, The Third Central Hospital of Tianjin, Tianjin, China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China;Artificial Cell Engineering Technology Research Center, Tianjin, China;Tianjin Institute of Hepatobiliary Disease, Tianjin, China;Hepatobiliary Surgery, The Third Central Hospital of Tianjin, Tianjin, China;

关键词: portal hypertension;    gastroesophageal varices;    choledochal cyst;    cholangiointestinal anastomotic stricture;    case report;   

DOI  :  10.3389/fmed.2023.1149484

 received in 2023-01-22, accepted in 2023-05-04,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundCystectomy accompanied by biliary system reconstruction is an important treatment option for choledochal cysts, but the risk of post-operative complications is high. The most famous long-term complication is anastomotic stricture, whereas non-cirrhotic portal hypertension secondary to cholangiointestinal anastomotic stricture is rare.Case summaryHere we report the case of a 33-year-old female patient with a type I choledochal cyst who underwent choledochal cyst excision with Roux-en-Y hepaticojejunostomy. Thirteen years later, the patient presented with severe esophageal and gastric variceal bleeding, splenomegaly, and hypersplenism. Furthermore, cholangiointestinal anastomotic stricture with cholangiectasis was identified on imaging. A pathological examination of the liver suggested intrahepatic cholestasis, but the fibrosis was mild and inconsistent with severe portal hypertension. Therefore, the final diagnosis was portal hypertension secondary to a cholangiointestinal anastomotic stricture after choledochal cyst surgery. Fortunately, the patient recovered well after endoscopic treatment and dilated cholangiointestinal anastomotic stricture.ConclusionCholedochal cyst excision with Roux-en-Y hepaticojejunostomy is the recommended standard of care for type I choledochal cysts; however, the long-term risk of cholangiointestinal anastomotic stricture requires consideration. Moreover, cholangiointestinal anastomotic stricture can lead to portal hypertension, and the degree of elevated portal pressure may be inconsistent with the degree of intrahepatic fibrosis.

【 授权许可】

Unknown   
Copyright © 2023 Zhang, Yan, Gao, Song and Lou.