SUMP SYNDROME: A RARE BUT PERSISTENT COMPLICATION OF CHOLEDOCHODUODENOSTOMY

Sump syndrome is a rare and often overlooked long-term complication of biliary enteric anastomoses,particularly side to side choledochoduodenostomy (CDD). This surgical procedure was commonly performed in the pre-endoscopic retrograde cholangiopancreatography (ERCP) era to achieve durable biliary drainage in patients with complicated choledocholithiasis or recurrent cholangitis [1,2].Following CDD, the distal segment of the common bile duct (CBD) between the anastomosis and the ampulla of Vater may become functionally excluded from biliary flow, forming a poorly drained reservoir prone to bile stasis, debris accumulation, infection, and stone formation, a condition referred to as sump syndrome [1,3]. Because symptoms may occur decades after surgery and imaging findings can be subtle, diagnosis is frequently delayed or missed.