Choledocho-Bulbostomy

Approx. 1960 Cholecystectomy with following Choledocho-duodenostomy

1966 Cholangitis with foreign body extraction from DHC

2004 admission because of macrohaematuria, upper abdomen pain, and disorientation

Clinical findings

Pressure pain in middle lower abdomen, otherwise age-appropriate physical examination.

Imaging process

Sonography 1996: Aerobilia, no signs of cirrhosis
Sonography2004: Pronounced Aerobilia, signs of nodular liver cirrhosis with splenomegaly and slight ascites.

EGD: Esophageal varices I °, Hypertensive gastropathy with small to 10mm large stomach polyps and blood deposits. In the bulb 1.5 cm wide bilio-duodenal anastomosis which has to be intubated up to the hepatic fork. In the beginning of ductus choledochus 1 cm large polyp.

ERC 1996: Metal-dense fragments in ductus choledochus with large bile duct fistula in duodenal bulb. The metal splitter is extracted with a basket. Intrahepatic unremarkable ductal system.

ERC 2004: Intrahepatic narrow bile ducts such as in liver cirrhosis, otherwise unchanged finding with above-named fistula.

Histology	Fatty liver with dissociated hepatocellular single necrosis
Diagnosis	Atypically situated and wide choledocho-bulbostomy with metal splitter in ductus choledochus
DD	Gallstone perforation
Course	1996: After removal of the metal splitter, which presumably came from the bulb to the surgical anastomosis into the ductus choledochus, the cholangitis ceased rapidly. 2004: Non-irritating anastomosis with liver cirrhosis of unknown origin.

Choledocho-Bulbostomy

Clinical findings

Imaging process

Cases: