Laparoscopic Assisted Trans-enteric Endoscopic Retrograde Cholangiogram via Roux Limb for Primary Hepatolithiasis

Paige Quintero, MD, Siddharth Kudav, MD, Hammoud Ghassan, MD, Roger de la Torre, MD. University of Missouri.

Primary hepatolithiasis is an uncommon etiology of obstructive jaundice in the United States. The condition is more prevalent in Asia, and in patients with altered anatomy due to previous operations. Various methods for stone extraction after hepaticojejunostomy have been described, usually requiring laparotomy for access to the roux limb, with subsequent ERCP or laser lithotripsy. We present a case of laparoscopic-assisted, trans-enteric ERCP to address primary hepatolithiasis in a 53-year-old female with a history of hepaticojejunostomy after hepatic trauma.


The patient had suffered significant abdominal trauma after being struck by a vehicle 35 years ago, and had required multiple abdominal operations including a partial liver resection and hepaticojejunostomy. She had been worked up for progressive hyperbilirubinemia, and was found to have primary hepatolithiasis. Using a multi-disciplinary approach, we were able to address her obstructive pathology with a minimally invasive procedure, with subsequent clinical improvement and decrease in her hyperbilirubinemia

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