Unusual Bile Duct Problems: The Sump Syndrome

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'Sump syndrome' is a rare but notorious complication of a side-to-side choledochoduodenostomy, typically presenting with recurrent obstructive jaundice or frank ascending cholangitis.
The pathophysiology involves the accumulation of food and debris entering the biliary tree through the wide surgical anastomosis, which then collects and stagnates in the 'sump' of the distal bile duct.
Due to subsequent malfunction or stenosis of the sphincter of Oddi, the trapped debris cannot be naturally excreted through the papilla; definitive treatment is surprisingly straightforward, requiring standard ERCP with biliary sphincterotomy and aggressive ductal sweeping.

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In the past, performing a side-to-side anastomosis of the bile duct to the duodenum (choledocoduodenostomy) was a quite common operation. This operation is now seldomly performed, but we still patients who underwent it.
The “Sump syndrome” is a rare complication of a side-to-side choledochoduodenostomy that usually presents with obstructive jaundice or ascending cholangitis.
Sump syndrome develops due to the accumulation of food and debris entering through the choledocoduodenostomy and being collected inside of the distal bile duct.
The debris cannot be excreted through the papilla due to malfunction of the sphincter of Oddi, as the main orifice of bile excretion into the duodenum is the choledocoduodenostomy, which is the path of least resistance.
At one point there is so much “dirt” inside the bile duct that obstruction and infection (cholangitis) ensue.
Treatment is easy: biliary sphincterotomy with cleansing of the bile ducts.
However, knowledge of this condition is essential for proper recognition and treatment. Lack of knowledge of the sump syndrome condition may lead to incomplete or failed ERCP and persistent cholangitis or choledocolithiasis.

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