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Case Reports
. 2014 Nov 13;8(3):358-63.
doi: 10.1159/000369298. eCollection 2014 Sep.

Mind the sump! - diagnostic challenge of a rare complication of choledochoduodenostomy

Ulf Zeuge  1 , Martin Fehr  2 , Christa Meyenberger  3 , Michael Christian Sulz  3
Affiliations
Case Reports

Mind the sump! - diagnostic challenge of a rare complication of choledochoduodenostomy

Ulf Zeuge et al. Case Rep Gastroenterol. .

Abstract

Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). Frequently only pneumobilia, serving as sign for functioning biliary-enteric anastomosis, is reminiscent of the former surgery. We present the case of an 81-year-old patient with sump syndrome who presented with clinical signs of ascending cholangitis, decades after the initial CDD procedure. Finally the detailed medical history that was taken very thoroughly in combination with the presence of pneumobilia led to the suspicion of sump syndrome. Sump syndrome was diagnosed by ERCP, and after endoscopic debris extraction and antibiotic treatment the patient recovered quickly. In the ERCP era little is known about CDD and its long-term complications, especially by young colleagues and trainees. Therefore this report provides an excellent opportunity to refresh the knowledge and raise awareness for this syndrome.

Keywords: Biliary tract disease; Cholangitis; Choledochoduodenostomy; Complication; Endoscopic retrograde cholangiopancreatography; Pneumobilia; Sump syndrome.

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Figures

Fig. 1
Fig. 1
CT scan of the abdomen. a Arrowheads show pneumobilia. b Arrowheads show HPVG.
Fig. 2
Fig. 2
a ERCP: Filling defects in the distal CBD (arrowheads) reveal impaction of abundant debris (for a schematic account see fig. 3). b Endoscopy: Dormia basket with ‘fruit skin’-like material (arrowheads) extracted after sphincterotomy.
Fig. 3
Fig. 3
Schematic drawing of CDD. The distal CBD is excluded from draining bile flow and consequently transforms into a poorly drained reservoir, functioning as a so-called ‘sump’. When the sump gets symptomatic due to collected stones and debris it provides the basis for sump syndrome. Reprinted with permission from the American Journal of Roentgenology [10].
See this image and copyright information in PMC

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