Massive Hepatolithiasis Due to Sump Syndrome

The patient is a 77-years-old female with cholecystectomy for cholelithiasis at 27 years old. At 65 years old choledochoduodenostomy for choledocholithiasis was practiced, suffering after that a sump syndrome with numerous cholangitis.

After initial endoscopic treatment and given the bad evolution a magnetic resonance was conducted, showing a cholangitis with severe dilatation and lithiasis of the biliary tree except in the intrahepatic branches of the right hepatic duct and left hepatic fibrosis (Figs. 1 and 2).

Fig. 1

Fig. 2

Finally, a left hepatectomy, intraoperative right hepatic endoscopic lithotomy, choledochoduodenostomy resection and new Roux-en-Y hepaticojejunostomy was carried out.

The anatomopathological examination described an acute and chronic cholangitis with moderate steatosis (Grade II in Brunt scale) and portal and periportal fibrosis (Grade II in Metavir scale).