Hepaticojejunostomy and long-term interventional treatment for recurrent biliary stricture after proximal bile duct injury: A case report.

BACKGROUND: Proximal bile duct injury (BDI), which often occurs after laparoscopic cholecystectomy (LC), can lead to complex biliary stricture and recurrent cholangitis. This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017, leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018. Despite these interventions, persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment. Imaging studies revealed persistent stricture at the site of hepaticojejunostomy, prompting a series of percutaneous procedures, including balloon dilatation and biliary drainage. In August 2024, she underwent biodegradable biliary stenting, which significantly improved her condition. Subsequently, she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests. This case highlighted the complexities of managing postinjury biliary stricture, underscored the potential of biodegradable stents as an effective treatment option, and emphasized the need for a multidisciplinary approach in managing such complications. Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.

CASE SUMMARY: A 39-year-old female had a routine LC in 2017. The patient sustained a proximal BDI during the surgery. In the months that followed, recurrent bouts of cholangitis occurred. A hepaticojejunostomy biliary reconstruction was performed in 2018. However, hepatic cholangitis persisted. In 2021 and 2022, MRCP scans revealed biliary stasis, duct dilation, and a stricture at the hepaticojejunostomy site. A subsequent percutaneous transhepatic cholangiography (PTC) confirmed these findings and led to drain placement. The treatment included internal and external biliary drain placements, repeated balloon dilations of the stricture, percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis, and insertion of a biodegradable biliary stent. Since the first PTC intervention, there have been no hospital admissions for cholangitis. Liver function tests showed improvement, and for five months following the biodegradable stenting, the condition remained stable. Long-term surveillance with regular imaging and blood work has been emphasized. The final diagnosis is recurrent biliary stricture secondary to proximal BDI. Treatment, including hepaticojejunostomy, repeated PTC with balloon dilation, and biodegradable biliary stenting, has led to complete drainage of the biliary system. Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.

CONCLUSION: This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC. A customized and multidisciplinary approach to control chronic biliary disease was proven effective, as shown by the patient's good outcome. This was achieved by integrating balloon dilatation sessions, biliary drainage, stone clearing, and biodegradable stent placement. Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.