Collaboration of Laparoscope and Endoscope for the treatment of Obstructive Jaundice with duodenal diverticulum

Saseem Poudel, MD, Kazuyuki Yokoyama, MD, PhD, Hiroki Chiba, MD, PhD, Hideaki Yoshida, MD, PhD

Yoichi Kyoukai Hospital

Introduction: Duodenal diverticulum is a rare entity, known to make ERCP procedure harder and increasing the risk of complication. We experienced a case of obstructive jaundice with cholelithiasis, complicated with pancreatic head tumor and massive duodenal diverticulum.

Case: 86 years old male was admitted for the treatment and investigation of obstructive jaundice. Investigations revealed cholecystitis, cholangitis, cholelithiasis, and cystic tumor in pancreas head. The patient was first observed with PTGBD and antibiotics. ERCP was attempted later for further investigation of the pancreatic head tumor and cause of obstructive jaundice as well as to place a tube stent over the stenotic portion. However massive duodenal diverticulum was found near the vater ampulla, and cannulation of the ampulla was unsuccessful. We thus opted for surgical procedure.

Procedure: The patient underwent laparoscopic cholecystectomy. During the procedure, a guidewire was inserted laparoscopically via cystic duct down to the common bile duct. It was caught by Endoscope and tube stent was placed endoscopically along the guidewire. Postoperative course was uneventful. The stent placement not only prevented the postoperative obstructive jaundice but also facilitated subsequent ERCP procedures.

Conclusion: By collaboration of Laparoscope and endoscope, we were able to perform minimally invasive treatment of obstructive jaundice complicated with duodenal diverticulum, with relative ease and without any complications.

Session: Poster Presentation

Program Number: P332

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