Successful treatment of percutaneous transhepatic papillary dilation in patients with obstructive jaundice due to common bile duct stones after Billroth II gastrectomy - Report of two emergent cases

Successful treatment of two patients with obstructive jaundice due to chole docholithiasis after Billroth II gastrectomy was performed by elimination o f stones by percutaneous transhepatic balloon dilatation of the sphincter o f Oddi. Patient 1 was an 82-year-old man and Patient 2 was a 73-year-old ma n. Both patients presented with obstructive jaundice. The papilla was not o bserved in either patient because of previous Billroth II gastrectomy. Beca use an endoscopic approach was impossible, percutaneous transhepatic cholan giodrainage (PTCD) was performed to alleviate jaundice. Choledocholithiasis was treated as follows: The sphincter of Oddi was dilated by percutaneous transhepatic balloon, and stone particles were removed from the papilla wit h a stone-eliminating balloon catheter via the same route of PTCD. This met hod is less invasive than the percutaneous transhepatic cholangioscopic met hod, and the use of existing appliances such as a balloon for papillary dil ation is possible. Hence, this method appears to be an effective and simple method for the treatment of choledocholithiasis after gastrectomy that is difficult to treat endoscopically.