Sump Syndrome

Sump syndrome is a late complication of side-to-side choledochoduodenostomy, a biliary-enteric anastomosis once commonly performed for benign bile duct disease. The distal common bile duct, no longer in the main path of bile flow, becomes a stagnant pouch (the "sump") that accumulates debris, food particles, stones, and bacterial overgrowth. This can present years to decades after the original surgery.

Patients typically present with cholangitis, recurrent right upper quadrant pain, abnormal liver tests, or pancreatitis. Imaging often shows a dilated distal common bile duct with debris and pneumobilia from the existing anastomosis, which can confuse the picture.

ERCP is both diagnostic and therapeutic — sphincterotomy with sweeping of the distal duct removes accumulated debris and stones, and improves drainage. Repeat ERCPs may be required for recurrent symptoms; refractory cases or those with anastomotic stricture may warrant surgical revision (typically conversion to a Roux-en-Y hepaticojejunostomy).