Giant anastomotic stone and hepatic abscess - a 40-year delayed complication of Roux-en-Y hepaticojejunostomy

Sep 30, 2026

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Letter to the Editor describing a rare, extremely delayed complication after Roux-en-Y hepaticojejunostomy: a giant anastomotic stone presenting 40 years after surgery, complicated by a secondary hepatic abscess. The report emphasizes that such large stones within the intestinal loop are exceptional, and that long-term biliary reconstruction may lead to uncommon outcomes. Imaging-centered diagnosis and multimodal management are highlighted, supported by MRI and CT findings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Introduction

Case presentation

Diagnostics and imaging

Treatment

Letter to the Editor Giant anastomotic stone and hepatic abscess: a 40-year delayed complication of Roux-en-Y hepaticojejunostomy Lining Dong1\#, Feiyu Chen1,2\#, Zhenchang Wang1, Xuan Wei1^ 1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China; 2Department of Radiology, Yongchuan People’s Hospital of Chongqing, Chongqing, China \#These authors contributed equally to this work. Correspondence to: Zhenchang Wang, MD; Xuan Wei, MD. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Road, Xicheng District, Beijing 100050, China. Email: [cjr.wzhch@vip.163.com](cjr.wzhch@vip.163.com); [weixuan315@163.com](weixuan315@163.com). Submitted Aug 01, 2025. Accepted for publication Oct 17, 2025. Published online Dec 31, 2025. doi: 10.21037/qims-2025-1668 View this article at: [https://dx.doi.org/10.21037/qims-2025-1668](https://dx.doi.org/10.21037/qims-2025-1668) Introduction Roux-en-Y hepaticojejunostomy is a standard procedure for biliary reconstruction (1) . However, this anatomical alteration can lead to long-term complications, such as cholangitis, biliary strictures, and stone formation . Although the formation of stones within the bile ducts following this surgery has been documented, the occurrence of large stones within the intestinal loop is an exceptionally rare complication. Herein, we report a case of a giant stone diagnosed 40 years after hepaticojejunostomy, which was complicated by a secondary hepatic abscess. The primary aim of presenting this case is to highlight the potential for extremely delayed and unusual complications following bilioenteric anastomosis and to underscore the critical role of multimodal imaging in the diagnosis and management of such complex conditions. Case presentation A 69-year-old female patient had undergone cholecystectomy and bilioenteric anastomosis at another hospital 40 years earlier. However, the specific etiology and surgical techniques were unknown. She initially presented to the outpatient clinic of our hospital with complaints of abdominal pain and fever. Additionally, she reported increased nocturnal urination and darker urine color. No other significant abnormal symptoms or signs were observed. Laboratory tests revealed anomalies in multiple indicators, including mild aminotransferase elevation, increased neutrophil and monocyte counts, elevated alkaline phosphatase, gammaglutamyl transferase, and direct bilirubin levels, along with hypoalbuminemia, reduced total protein, low calcium, and low cholesterol levels. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal. Upon admission, the physician arranged for additional diagnostic procedures, which sequentially included noncontrast and contrast-enhanced abdominal magnetic resonance imaging (MRI), ultrasound-guided puncture drainage of the abscess and biopsy of the space-occupying lesion between the liver and pancreas, as well as noncontrast and contrast-enhanced abdominal computed tomography (CT) . The condition was ultimately treated with surgery. Non-contrast and contrast-enhanced abdominal MRI scans revealed a large abnormal lesion between the ^ ORCID: 0000-0002-5797-4928. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):103 | [https://dx.doi.org/10.21037/qims-2025-1668](https://dx.doi.org/10.21037/qims-2025-1668) Page 2 of 7 Dong et al. Late giant stone and abscess after hepaticojejunostomy Figure 1 MRI images of lesions between the liver and pancreas. (A) T1WI,(B) T2WI,(C) DWI (b=0),(D) DWI (b=800),(E) ADC,(F) pre-contrast T1WI, (G) earl

FAQs

What long-term complication can occur after Roux-en-Y hepaticojejunostomy?

The document highlights extremely delayed and unusual complications, including formation of stones and, in this case, a giant anastomotic stone complicated by a secondary hepatic abscess.

How long after surgery was the giant stone diagnosed?

The giant stone was diagnosed 40 years after the hepaticojejunostomy.

What diagnostic approach was emphasized in managing this complex condition?

Multimodal imaging played a critical role, including non-contrast and contrast-enhanced abdominal MRI and CT, along with ultrasound-guided drainage and biopsy.

Sep 30, 2026

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