A 13 year old girl presented with Pain, fever & jaundice off & on for 6 months. She was operated for possible choledochal cyst with hepaticoduodenostomy at the age of 3 years. She had jaundice, leukocytosis & significantly dilated Intrahepatic biliary radicles studded with thousands of tiny stones. We could not visualize or locate hepaticoduodenostomy stoma on upper GI scopy. Percutaneous transhepatic cholangiography was done which revealed significantly dilated IHBR more severe dilatation on left side with total block at the level of confluence. The biliary radicles were full of tiny stones.
Interventional radiologist could pass guide wire across the block into duodenum through stenosed stoma. The stoma was dilated by 6mm balloon dilator by transhepatic route. After dilatation bile with numerous small stones were seen flowing out. An interno-external plastic stent was placed. For 1 week patient had relief from jaundice, fever & pain.
She was advised to undergo ROUX-EN-Y hepaticojejunostomy. The relatives refused 1 more surgery. The interno-external stent was removed. A Lumen Apposing Metallic Stent ( LAMS ) of 1cm diameter was placed across the stoma. At the end of 15 days patient is totally asymptomatic. We planned to remove LAMS at the end of 3 months by which we expect good dilatation of stoma.