A case report: regarding transduodenal sphincteroplasty

Abstract

Introduction: Stenosing papillitis is rare. It can be primary or secondary and occurs due to the presence of stones in the common bile duct. The initial treatment of choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP). However, when ERCP is unsuccessful, the transduodenal sphincteroplasty is an alternative strategy that obtains satisfactory results in select patients. Case description: A 27-year-old female patient presents right-upper quadrant pain associated with scleral icterus. She had choledocholithiasis and cholestasis. The ERCP performed was failed, so an open cholecystectomy with common bile duct exploration was undertaken. As the ampulla could not be cannulated, a “T” tube was placed. On a postoperative day 15, a cholangiography was performed without evidence of contrast passage into the duodenum. A re-exploration of the bile duct was undertaken 30 days after and a papillary exploration through a transduodenal approach was performed. A new cholangiography was done on postoperative day 9, at which point adequate passage of contrast into the duodenum was appreciated. Conclusion: Transduodenal sphincteroplasty is a procedure rarely performed in the era of endoscopy. Nonetheless, when these cases do come up, knowing the appropriate surgical technique is crucial to obtain satisfactory results for the patient.