Gallstones in bili-digestive shunts diagnosed by ultrasound. An unusual cause of obstruction.

In 4 patients treated surgically with a bili-digestive shunt, 2 because of pancreatic carcinoma and 2 because of chronic pancreatitis with cellular atypias, stones (with acoustic shadow) or sludge formation in the common bile duct were observed at postoperative ultrasonography (US) and confirmed by percutaneous transhepatic cholangiography. Clinical signs were abnormal liver function tests occasionally combined with relapsing attacks of cholangitis. All entero-anastomoses were narrow; surgical revision was done in 2 of the patients while 2 were percutaneously dilated. Except for the stones and detritus masses, the 'typical' US findings were absence of gas echoes in the periportal structures, normal width of bile ducts, or only a slight dilatation. US seems to be the method of choice for postoperative follow-up.