We report the case of an 83-year-old woman with hypertensive, dyslipidemic, ulcerated colitis who underwent antrectomy and Billroth-II reconstruction 50 years ago as treatment for peptic ulcer disease.
She came to the hospital with abdominal pain in the right hypochondrium and vomiting for 5 days.
She did not present jaundice or fever during examination.
Laboratory tests showed changes in liver function (GGT 386 IU/L, AP 337 IU/L, AST 245 U/L, ALT 342 U/L, and total bilirubin 0.03 g/l).
Hyperkalemia and C-reactive protein were also detected; in addition, there were signs of increased abdominal ultrasound, dilated bile ducts, gallbladder and extrahepatic bile ducts.
Established in all these guidelines, the diagnosis of acute lithium pancreatitis was established.
In the oral contrast study biliary drainage to the efferent loop was observed.
On the other hand, endoscopic findings did not provide new data.
Computed tomography (CT) revealed dilation of the extrahepatic bile duct, gallbladder, loop and loop and loop; also, there was an increase in the initial biliary ultrasound, but not in the initial manifestation of biliary stenosis.
On the other hand, increased levels of hyperbilirubinemia (97 g/l) as well as liver function tests (AST 600 U/L) after 15 days of hospitalization.
A laparotomy was indicated based on the diagnosis of acute lithiasic stenosis and progressive obstructive jaundice involving the afferent loop of the Billroth-II reconstruction.
We found biliary stricture and necrotic gallstone, and a volvulus afferent loop stenosis over the efferent loop causing obstructive jaundice.
The stenotic afferent loop was resected. Biliary stasis was identified and reconstruction was performed using Y-Roux-en-Y stent-jejunal reconstruction.
Cholecystectomy and intraoperative cholangiography were also performed, obtained at the end of the procedure, showing a satisfactory drainage through the papilla of Vater into the duodenum and later through the jejunum.
On the sixth postoperative day the levels of amylasemia and bilirubin returned to normal and the patient presented normal clinical examination and symptoms.
Jaundice disappeared completely before hospital discharge.
Histopathological examination revealed chronic colitis and intestinal asa presented nonspecific inflammatory signs and mucosa.
