Postoperative intraluminal blood clots after a hepaticojejunostomy: rare, fast-action complication
Abstract
Introduction: An intestinal obstruction due to intraluminal blood clots is a postoperative complication that is infrequently reported in literature. We reported the case of a patient with an intestinal obstruction due to postoperative intraluminal blood clots from a Roux-en-Y hepaticojejunostomy. Clinical Case: A 53-year-old male patient appeared with recurring cholangitis secondary to a benign stenosis of the bile duct after a laparoscopic cholecystectomy performed 2 years prior. Treatment with an endoprosthesis by endoscopic retrograde cholangiopancreatography (ERCP) did not improve cholangitis episodes, for which reason transition to reconstruction by hepaticojejunostomy was considered. He showed signs of intestinal obstruction during early postoperative care. The computed tomography (CT) scan of the abdomen with contrast showed free fluid and signs of obstruction. The patient was taken to an emergency surgery, where the Roux-en-Y anastomosis was found to be obstructed by a large intraluminal blood clot. It required an enterotomy to be extracted. Discussion: A postoperative intestinal obstruction secondary to intraluminal blood clots is unusual, but must be suspected in patients with symptoms of intestinal obstruction. The ideal method for diagnosis is by tomography and treatment involves a relaparotomy to extract the blood clots. It is important for doctors to have knowledge of this condition, since it is a rare complication that requires good diagnostic insight and timely treatment.
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