Sump Syndrome: A Rare Complication of Choledochojejunostomy

Before the period of endoscopic retrograde cholangiopancreatography (ERCP), individuals with biliary tract diseases would undergo side-to-side choledochoduodenostomy, and sump syndrome used to develop as a complication of this procedure. There is retention of bile along with debris or calculi, and refluxed duodenal contents in the common bile duct, which leads to biliary and pancreatic complications. This syndrome's pathophysiology often results when the distal common bile duct below the anastomosis becomes a blind pouch (sump), leading to stasis of bile, food debris, and bacteria, which can lead to obstruction and infection. Here, we present a case of sump syndrome as a rare complication of choledochojejunostomy. A patient with a history of post-choledochojejunostomy and redo hepaticojejunostomy, along with recurrent cholangitis, presented with abdominal pain, and initial radiological investigations suggested a pancreatic cyst. However, further endoscopic evaluation was done and revealed it to be a case of sump syndrome. ERCP followed by biliary sphincterotomy was done as a part of further management.