Percutaneous transhepatic biliary intervention for the management of recurrent cholangitis secondary to intrahepatic biliary stones after hepaticojejunostomy

Recurrent cholangitis, intrahepatic stones and biliary and anastomotic strictures are common complications after Roux-en-Y hepaticojejunostomy. The surgically altered anatomy makes management of these complications with endoscopic retrograde cholangiopancreatography technically difficult. We present a case of recurrent cholangitis in a 25-year-old woman with a prior hepaticojejunostomy. Intrahepatic stones, biliary strictures and hepaticojejunostomy strictures were treated using a combined percutaneous transhepatic cholangiography and cholangioscopy approach over several interventions. Minimally invasive, multidisciplinary approach to the management of intrahepatic biliary calculi and stricture after hepaticojejunostomy can be considered in cases where traditional endoscopic retrograde cholangiopancreatography intervention is too technically difficult.