Refractory Choledocholithiasis Causing Endogenous Endophthalmitis: A Case Report.

Publisher: International Scientific Information, Inc Country of Publication: United States NLM ID: 101489566 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-5923 (Electronic) Linking ISSN: 19415923 NLM ISO Abbreviation: Am J Case Rep Subsets: MEDLINE

Publication: <2014- > : Smithtown, NY : International Scientific Information, Inc.
Original Publication: Albertson, NY : International Scientific Literature, Inc.

Choledocholithiasis*/complications ; Choledocholithiasis*/surgery ; Diabetes Mellitus, Type 2*/complications ; Gallstones*/complications ; Cholecystectomy, Laparoscopic*/adverse effects ; Endophthalmitis*/etiology ; Endophthalmitis*/surgery ; Cholangitis*/etiology ; Cholangitis*/surgery; Male ; Humans ; Aged ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde/methods

BACKGROUND Endogenous bacterial endophthalmitis is caused by a breach of the blood-ocular barrier by pathogens originating from distant infective foci. Here, we report a case of endogenous endophthalmitis due to cholangitis complicated by common bile duct stones, which is a rare source of infection. CASE REPORT A 73-year-old man with type II diabetes mellitus underwent endoscopic choledocholithotripsy 20 years ago and laparoscopic cholecystectomy 18 years ago. He had choledocholith-related cholangitis 6, 5, and 1 years previously and 4 times in the last year and underwent endoscopic choledocholithotripsy each time. Three days after the last surgery, the patient developed right endogenous endophthalmitis and vitrectomy was performed. Four months later, the patient relapsed with cholangitis and required surgery for recurrent endophthalmitis. Roux-en-Y choledochojejunostomy was performed with curative intent, and the patient was followed up for 5 years without recurrence of choledocholith, cholangitis, or endophthalmitis. CONCLUSIONS The recommended treatment strategy for patients diagnosed with common bile duct stones or choledocholithiasis is stone extraction. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic intervention is a widely accepted procedure. However, in cases of recurrent choledocholithiasis, the rate of recurrence increases and the interval between ERCP becomes shorter in proportion to the number of recurrences. In such intractable cases requiring numerous sessions of endoscopic stone removal, bypass Roux-en-Y choledochojejunostomy should be performed to prevent possible rare complications such as endogenous bacterial endophthalmitis.

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Date Created: 20230214 Date Completed: 20230215 Latest Revision: 20230222

20240105

PMC9939846

10.12659/AJCR.938890

36785494