# Ascending cholangitis in gastric bypass patients following hepatobiliary scintigraphy and oral protein shake administration: a case report

## TL;DR

A gastric bypass patient developed cholangitis after a routine scan and meal test, leading to a new surgical approach for bile duct issues.

## Contribution

Presents a novel surgical technique for bariatric patients with bile duct complications.

## Key findings

- Ascending cholangitis occurred after hepatobiliary scintigraphy in a gastric bypass patient with cholelithiasis.
- Transcystic common bile duct exploration with balloon dilation resolved CBD outlet obstruction.
- The case highlights a potential risk of imaging modality in patients with preexisting gallstones.

## Abstract

We present the unusual case of a 66-year-old female who was found to have ascending cholangitis following hepatobiliary scintigraphy and fatty meal administration, in the setting of isolated cholelithiasis. Given her surgical history of Roux-en-Y gastric bypass, a robotic cholecystectomy with transcystic common bile duct (CBD) exploration was performed. Patient was discharged on post-operative day (POD) 7 with a T-tube following antibiotic completion. Tube study at 1 week confirmed resolution of her CBD outlet obstruction. Acute cholangitis is a concerning outcome following hepatobiliary iminodiacetic acid scan and cholecystokinin (CCK) administration in patients with preexisting cholelithiasis. We do believe that this is a risk that warrants consideration and informed patient discussion when using this imaging modality. We also present an early experience with transcystic common bile duct exploration with balloon dilation. A technique, we believe, will be of benefit for our bariatric patient population when presenting with choledocholithiasis or acute cholangitis.