Post Cholecystectomy Recurrent Acute Pancreatitis Secondary to Sump Syndrome

Abstract

The sump syndrome, presents usually with cholangitis and its complications. The aim of this case report is to present a patient with sump syndrome who presented solely with recurrent pancreatitis, normal LFT's and no cholangitis. She was successfully treated by surgical closure of the choledochoduodenostomy, with sphincteroplasty and cholechojejunostomy, which resolved her recurrent episodes of acute pancreatitis. Case Report: A 44-year-old woman with a history of cholecystectomy 15 years ago, followed by a biliary by-pass (choledochoduodenostomy) one year later for choledocholithiasis, presented with recurrent episodes of acute pancreatitis and normal LFTs without cholangitis. Previously an endoscopic biliary papillotomy for presumed sump syndrome was performed however she continued to experience recurrent pancreatitis. She had experienced 8–10 episodes of acute pancreatitis over the preceding 5 years. There was no history of hypercalcemia, hypertriglyceridemia or abdominal trauma nor was she ingesting any medications. Evaluation included a normal abdominal CT scan; laboratory data showed elevated amylase and lipase. ERCP revealed a normal pancreatic duct with adequate drainage and a choledochoduodenostomy. She had a flat, normal-looking ampulla of Vater with signs of previous sphincterotomy that could not be endoscopically extended. Consequently, she underwent surgical closure of the choledochoduodenostomy, pancreatic sphincteroplasty and cholechojejunostomy. Subsequently, she progressed to good health and remained well without recurrent episodes of pancreatitis for the following 12 months. Sump syndrome should be considered as a cause of pancreatitis presumably via an obstructive mechanism