Elsayed G, Mohamed L, Almasaabi M, Barakat K, Gadour E. Hepaticojejunostomy and long-term interventional treatment for recurrent biliary stricture after proximal bile duct injury: A case report. World J Clin Cases 2025; 13(20): 104609 [DOI: 10.12998/wjcc.v13.i20.104609]
Corresponding Author of This Article
Eyad Gadour, MD, CCST, Consultant, FACP, FRCP, MRCP, Associate Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, Saudi Arabia. eyadgadour@doctors.org.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2025; 13(20): 104609 Published online Jul 16, 2025. doi: 10.12998/wjcc.v13.i20.104609
Hepaticojejunostomy and long-term interventional treatment for recurrent biliary stricture after proximal bile duct injury: A case report
Ghassan Elsayed, Lama Mohamed, Maryam Almasaabi, Khalid Barakat, Eyad Gadour
Ghassan Elsayed, Lama Mohamed, Maryam Almasaabi, Khalid Barakat, Department of Gastroenterology, Mediclinic Middle East Hospital, Abu Dhabi W67, Abu Dhaby, United Arab Emirates
Eyad Gadour, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
Eyad Gadour, Internal Medicine, Zamzam University College, School of Medicine, Khartoum 11113, Sudan
Author contributions: Elsayed G and Gadour E contributed to the conceptualization, writing, supervision, reviewing and editing of manuscripts, and project management; Mohamed L, Almasaabi M, and Barakat K contributed to resources; Mohamed L, Almasaabi M and Gadour E contributed to writing the final manuscript; and all authors read and agreed to the published version of the manuscript.
Informed consent statement: Written consent was obtained from the patients. Although, patient’s details kept confidential with no identifiable information used.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eyad Gadour, MD, CCST, Consultant, FACP, FRCP, MRCP, Associate Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, Saudi Arabia. eyadgadour@doctors.org.uk
Received: December 27, 2024 Revised: March 8, 2025 Accepted: March 20, 2025 Published online: July 16, 2025 Processing time: 103 Days and 23.4 Hours
Abstract
BACKGROUND
Proximal bile duct injury (BDI), which often occurs after laparoscopic cholecystectomy (LC), can lead to complex biliary stricture and recurrent cholangitis. This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017, leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018. Despite these interventions, persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment. Imaging studies revealed persistent stricture at the site of hepaticojejunostomy, prompting a series of percutaneous procedures, including balloon dilatation and biliary drainage. In August 2024, she underwent biodegradable biliary stenting, which significantly improved her condition. Subsequently, she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests. This case highlighted the complexities of managing postinjury biliary stricture, underscored the potential of biodegradable stents as an effective treatment option, and emphasized the need for a multidisciplinary approach in managing such complications. Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.
CASE SUMMARY
A 39-year-old female had a routine LC in 2017. The patient sustained a proximal BDI during the surgery. In the months that followed, recurrent bouts of cholangitis occurred. A hepaticojejunostomy biliary reconstruction was performed in 2018. However, hepatic cholangitis persisted. In 2021 and 2022, MRCP scans revealed biliary stasis, duct dilation, and a stricture at the hepaticojejunostomy site. A subsequent percutaneous transhepatic cholangiography (PTC) confirmed these findings and led to drain placement. The treatment included internal and external biliary drain placements, repeated balloon dilations of the stricture, percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis, and insertion of a biodegradable biliary stent. Since the first PTC intervention, there have been no hospital admissions for cholangitis. Liver function tests showed improvement, and for five months following the biodegradable stenting, the condition remained stable. Long-term surveillance with regular imaging and blood work has been emphasized. The final diagnosis is recurrent biliary stricture secondary to proximal BDI. Treatment, including hepaticojejunostomy, repeated PTC with balloon dilation, and biodegradable biliary stenting, has led to complete drainage of the biliary system. Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.
CONCLUSION
This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC. A customized and multidisciplinary approach to control chronic biliary disease was proven effective, as shown by the patient’s good outcome. This was achieved by integrating balloon dilatation sessions, biliary drainage, stone clearing, and biodegradable stent placement. Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
Core Tip: Effective management of recurrent biliary stricture following proximal bile duct injury requires a multidisciplinary approach, including timely surgical intervention, such as hepaticojejunostomy, and regular imaging using advanced techniques, such as magnetic resonance cholangiopancreatography. Incorporating innovative treatment modalities, such as biodegradable biliary stenting, can significantly improve patient outcomes by enhancing patency without the need for stent removal. Regular follow-up visits are crucial to assess stricture remodeling and prevent recurrence. Clinicians should remain vigilant for signs of cholangitis and be prepared to implement a combination of endoscopic and percutaneous interventions to ensure optimal management of complex biliary complications.
