POST‐CHOLEDOCHOENTEROSTOMY ‘SUMP SYNDROME’

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Abstract
The ‘sump syndrome’ is an uncommon, late complication of a side‐to‐side choledochoenterostomy. Five patients with this syndrome were encountered over a 5‐year period. Pain or cholangitis was the clinical presentation in four patients, whereas one patient presented with secondary septic arthritis and a hepatic abscess. Liver function tests were mildly abnormal in each patient. All patients had a stomal size of less than 1 cm as assessed by forward‐ or side‐viewing endoscopy. Endoscopic retrograde cholangiography revealed either stones or debris in the distal common bile ducts of all patients. Four patients had a surgical clearance of their duct with concurrent closure of the choledochojejunostomy in three patients and the creation of a Rouxen‐Y end‐to‐side choledochojejunostomy in the fourth patient. The other patient had an endoscopic sphincterotomy performed. After 1–4 years of follow‐up, four patients have had a total resolution of symptoms. The other patient with follow‐up for 4 years has had one episode of cholangitis which resolved rapidly with antibiotic treatment.The pathogenesis and clinical spectrum of the sump syndrome are reviewed and current management strategies are discussed.