Mucosal dysplasia in the bile duct after choledochoduodenostomy: A case report

A 60-year-old woman who had undergone cholecystectomy, choledocholithotomy and choledochoduodenostomy 21 years previously for cholecystolithiasis and choledocholithiasis, presented with nausea and vomiting. With a preoperativ e diagnosis of recurrent common bile duct stones, the extrahepatic bile duc t was excised and choledochojejunostomy was performed. Histologic examinati on of the resected specimen disclosed chronic cholangitis, papillary epithe lial hyperplasia, and mild dysplasia. Choledochoduodenostomy predisposes to reflux of duodenal contents, resulting in chronic-mechanical and chemical irritation likely to induce histopathologic alterations in the bile duct mu cosa. Since bile duct dysplasia induced by chronic inflammation maybe a pre cursor of cancer, indication for choledochoduodenostomy should be specific and limited, and careful long-term follow-up is mandatory.