Hepatic ductoplasty for iatrogenic Bismuth type 2 bile duct stricture: A case report

INTRODUCTION: Biliary enteric anastomosis is a well-known biliary reconstruction method. Anastomosis stricture is one of the complications of this procedure that occurs in some patients over the long-term. We report a successful case of hepatic ductoplasty combined with hepaticojejunostomy (H–J) for the treatment of iatrogenic Bismuth type 2 stricture. PRESENTATION OF CASE: The patient was a 68-year-woman who had undergone choledochojejunostomy (C–J) 6 years earlier due to bile duct injury after laparoscopic cholecystectomy for cholelithiasis. She complained of recurrent chills and upper back pain. Cholangiography and computed tomography revealed a C–J anastomotic stricture with hepatolithiasis. The diagnosis was reflux cholangitis with hepatolithiasis due to C–J stricture and a fistula between the reconstructed jejunal limb and duodenum. Exploration was performed, and she underwent hepatic ductoplasty with H–J and hepaticolithotripsy. Surgery was performed uneventfully and the patient has remained well subsequently. DISCUSSION AND CONCLUSION: We propose hepatic ductoplasty as a useful technique for the treatment of selected patients with a C–J stricture or narrow hepatic duct.