Late cholangitis without jaundice due to a retained distal bile duct stump after hepaticojejunostomy: a case report

Biliary tract injuries are among the rare but serious complications of cholecystectomy, and Roux-en-Y hepaticojejunostomy is the most commonly preferred surgical treatment for major injuries. The most common late complications following this procedure are anastomotic stricture and recurrent cholangitis. However, complications arising from failure to excise the distal bile duct segment are quite rare. A 67-year-old female patient underwent hepaticojejunostomy in 1997 due to a bile duct injury sustained during cholecystectomy. Years later, the patient presented with recurrent cholangitis attacks and underwent surgery with a preliminary diagnosis of hepaticojejunostomy stricture. During follow-up, the patient developed recurrent cholangitis, with infection-related findings predominating in the absence of jaundice. Imaging and further evaluation revealed stones in the distal common bile duct segment, and the stones and purulent content were successfully extracted using endoscopic retrograde cholangiopancreatography (ERCP). In cases of cholangitis developing after hepaticojejunostomy, not only the anastomotic site but also the distal bile duct segment should be evaluated. Failure to excise the distal common bile duct segment can, although rare, lead to a sump-like pathophysiological mechanism presenting with late-onset stone formation and cholangitis without jaundice.