Percutaneous transhepatic balloon dilatation of the hepaticojejunal anastomosis for the definitive treatment of the intrahepatic bile duct stones occurring in choledochal cysts excised children

Abstract

Cyst excision with hepaticojejunostomy is the well defined standard treatment for choledochal cysts. Intra or extrahepatic bile duct stone formation are serious complications observed in long-term follow-up after hepaticojejunostomy. Revision of hepaticojejunostomy is the most defined treatment of intra or extrahepatic bile duct stones secondary to hepaticojejunal anastomotic stenosis. We report two cases of common hepatic duct and/or intrahepatic bile duct stones that developed after hepatico-jejunostomy for choledochal cyst resection, that were treated with percutaneous transhepatic balloon dilatation of the hepaticojejunal anastomotic stenosis. During percutaneous transhepatic cholangiography a catheter was passed through the hepaticojejunal anastomotic stenosis and the hepatic duct-jejunal anastomotic junction was dilated with a balloon. The common hepatic duct stone and intrahepatic bile duct stones thus passed to the jejunum following the dilatation. The patients recovered uneventfully and are free of stones. • Intra or extrahepatic bile duct stone formation are observed in after hepaticojejunostomy. • Hepaticojejunal anastomotic stenosis can be treated with percutaneous transhepatic balloon dilatation. • Percutaneous transhepatic balloon dilatation is definitive treatment of the intrahepatic bile duct stones.