Cholangitis as a late complication of choledochoduodenostomy: the sump syndrome

Abstract

An 84-year-old woman was admitted for cholangitis. Her leukocyte count was 14.76 Gpt/L (normal range 4.0 – 10.0 Gpt/L), total bilirubin was 67 mmol (normal < 17 mmol), alkaline phosphatase was 6.48 mmol (normal range 0.58 – 1.74 mmol) and γ-glutamyltransferase was 7.04 (normal range 0.1 – 0.7). The past medical history was remarkable for a cholecystectomy and a choledochoduodenostomy carried out 21 and 15 years ago, respectively. An abdominal ultrasound carried out after admission to the referring hospital showed dilation of the common bile duct (CBD) and choledocholithiasis. Therapy with tazobactam/piperacillin and metronidazole was started. Endoscopic retrograde cholangiopancreatography (ERCP) was carried out twice at the same hospital but failed both times, and the patient was referred to our medical center.