Recurrent ascending cholangitis secondary to food reflux following transduodenal resection of an ampullary adenoma - Case report

Sep 28, 2026

Uploaded by Himbo

Recurrent ascending cholangitis developed in a 68-year-old woman after transduodenal ampullectomy for an ampullary adenoma, with repeated jaundice and episodes requiring frequent ERCP to clear the common bile duct. Despite treatment for presumed CBD stones and cholestasis, imaging showed dilated bile ducts, pneumobilia, and filling defects adjacent to a stent, while ERCP demonstrated food particles rather than stones. Definitive management used open hepaticojejunostomy with gastrojejunostomy to disconnect the biliary system from the alimentary stream, achieving postoperative recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Background

Case history

Investigation and ERCP findings

Surgical management and outcome

Figures

CASE REPORTS DOI: 10. 1308/rcsann.2024.0110 Recurrent ascending cholangitis secondary to food reflux following transduodenal resection of an ampullary adenoma Ampullary lesions, including adenomas and early-stage carcinomas, pose a diagnostic and therapeutic challenge because of their location and proximity to the pancreatic and bile ducts. Transduodenal ampullectomy offers a targeted approach for the resection of these lesions while preserving the integrity of the pancreaticobiliary system. Moreover, transduodenal ampullectomy is associated with favourable postoperative outcomes, including low rates of morbidity and mortality, as well as preservation of pancreatic and biliary function. However, potential complications such as ascending cholangitis pancreatic leakage, bleeding and duodenal stenosis can occur, which would impact the postoperative quality of life. Addressing these outcomes might require either endoscopic procedures or surgical interventions. We present an exceedingly uncommon case of recurrent ascending cholangitis resulting from reflux of food particles into the common bile duct that was treated successfully with a Roux-en-Y hepaticojejunostomy and gastroenterostomy. Keywords: Ampulla of Vater; Transduodenal ampullectomy; Recurrent cholangitis; Biliary lithiasis; Food reflux Background Transduodenal ampullectomy (TDA) is a well-described procedure for ampullary tumours.1–5 However, ampullectomy may lead to postoperative complications, including early sequelae such as pancreatitis, bleeding, perforation and cholangitis, which can often be adequately managed by nonoperative treatment. Late complications, such as pancreatic or biliary stenosis (0%–8%), can be addressed with endoscopic sphincterotomy, stent placement and balloon dilation.6 Reﬂux of food particles into the common bile duct, although relatively common after choledochoduodenostomy, has not been previously reported following TDA.7 We report a rare case of recurrent ascending cholangitis arising from the reﬂux of food particles into the common bile duct following surgical TDA. Case history A 68-year-old woman had undergone an open cholecystectomy and TDA for a tubulovillous adenoma of the ampulla of Vater in 2011 . Three years later, she experienced recurrent episodes of jaundice and cholangitis necessitating frequent endoscopic retrograde cholangiopancreatography (ERCP) to clear the common bile duct (CBD) . Initially, it was believed that the recurrent cholangitis was caused by the formation of primary CBD stones and cholestasis, leading to the patient being placed on regular ursodeoxycholic acid to reduce recurrence. However, further episodes of cholangitis continued to occur. She went on to have a total of 13 ERCPs for duct clearance between 2014 and December 2023 . When she developed recurrent cholangitis two weeks after an ERCP in 2024, further imaging studies including computed tomography (CT) scanning (Figure 1) and magnetic resonance cholangiopancreatography (MRCP) were performed. CT and MRCP showed dilated intra- and extrahepatic bile ducts, pneumobilia and ﬁlling defects in the CBD next to the stent. Subsequent ERCP revealed the presence of food particles rather than stones within a hugely dilated extrahepatic biliary tree (Figure 2) . Further CBD clearance and stent placement were performed as a bridging intervention until deﬁnitive surgical management. Following multidisciplinary discussion, a decision was made to proceed with open hepaticojejunostomy for bile duct reconstruction and gastrojejunostomy. The rationale was to disconnect the CBD (biliary system) from the alimentary stream. Moreover, this would allow access for endoscopic ultrasound and ERCP for future surveillance of the ampullectomy bed recurrence and instrumentation of the distal CBD in case food particles recollected. Intraoperatively, after transection of the common hepatic duct, multiple food particles and vegetable matter (Figure 3) M Fouad1,2 MW

FAQs

What caused the recurrent ascending cholangitis in this case?

The patient’s recurrent cholangitis was caused by reflux of food particles into the common bile duct, rather than by primary CBD stones.

What imaging and endoscopic findings supported the diagnosis?

CT and MRCP showed dilated intra- and extrahepatic bile ducts, pneumobilia, and CBD filling defects next to the stent. Subsequent ERCP revealed food particles within a markedly dilated extrahepatic biliary tree.

How was the condition treated definitively?

Multidisciplinary discussion led to open hepaticojejunostomy for bile duct reconstruction and gastrojejunostomy to disconnect the CBD from the alimentary stream, with successful postoperative recovery.

Sep 28, 2026

Uploaded by Himbo