From Diagnosis to Treatment of an Extreme Case of Sump Syndrome Presenting With Cholangitis.

This case report presents an extreme sump syndrome complicated by acute cholangitis. The patient, who underwent a Roux-en-Y hepaticojejunostomy (HJ) for a Type 1 choledochal cyst 10 years ago, had imaging findings of debris filling both lobes of the intrahepatic bile ducts (IHBD) and obstructing the anastomosis. Surgical or endoscopic intervention was not feasible, so percutaneous biliary drainage was performed. Two sequential procedures were performed. Initially, a 12F biliary drainage catheter was used, and saline irrigation was applied to facilitate debris resolution. However, after the removal of the catheter, residual debris obstructed the HJ anastomosis. In the second procedure, a balloon was used to displace the debris into the duodenum. The patient's acute cholangitis resolved within a week, and no further complications were observed during a one-year follow-up.