RECURRENT PYOGENIC CHOLANGITIS - SUMP SYNDROME FOLLOWING CHOLEDOCHODUODENOSTOMY

An uncommon and late complication of side-to-side choledochoduodenosto my (CDD), the 'sump syndrome', developed in a patient 4 years after su rgery. Recurrent right upper abdominal pain, fever with chills and rig ors and latterly, mild jaundice made her seek repeated hospital admiss ions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ER C), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) s can using Tc-99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal c learance. The closed end of the Rowe loop was placed subcutaneously fo r subsequent percutaneous access for cholangiography and removal of ca lculi. She is asymptomatic and well 28 months after surgery.