A novel endoscopic treatment of major bile duct leak

Abstract

INTRODUCTIONBile leak is a serious complication of hepatobiliary surgery. The incidence has remained the same over the last decade despite significant improvement in the results of liver surgery.PRESENTATION OF CASEA 21-year-old man was a passenger in a motor vehicle and sustained a blunt abdominal trauma in a high-speed collision leading to major liver laceration. He had right lobe hepatectomy complicated by major bile leak. He was not fit for further surgery and he, therefore, had ERCP and obliteration of the leaking bile duct using a combination of metallic coil and N-butyl cyanoacrylate.DISCUSSIONEndoscopic therapy has become the modality of choice in the treatment of biliary tract injuries. Different modalities of management of persistent bile leak such as sphincterotomy, plastic biliary stents, and nasobiliary drainage have been described. Obliteration of bile duct leak using N-butyl cyanoacrylate and coil embolization has been described but most of these reports used the percutaneous transhepatic approach.CONCLUSIONIn this paper, we describe the second reported case in English literature of a novel endoscopic technique using a combination of metallic coil embolization and N-butyl cyanoacrylate in a patient with major bile leak who was not a candidate for surgery as well as a third report of the late complication of coil migration to the common bile duct.

Endoscopic treatment of biliary leak following gunshot injury: A case report

“…Its management is comparatively more difficult than that of iatrogenic biliary injuries because of the frequently associated major organ injuries. [56] It is a rare event, accounting for 1%–3.5% of all abdominal injuries. [7] In a recent case report series of 14 traumatic biliary injuries over a period of 5 years treated at University of Texas Health Science Center, Houston, Texas, USA, only 3 cases were due to gunshot injuries.…”

Percutaneous embolization of cystic duct stump leak following failed endoscopic management

“…Biliary drain placement via a percutaneous transhepatic route can divert bile and promote passive healing similar to nasobiliary drain placement. Percutaneous cystic duct embolization has been performed with success and has been proposed as an alternative management strategy to endoscopy when direct access to the focus of leak is available [2] , [7] , [8] .…”

“…Vascular coils, n -butyl cyanoacrylate, and micropledgets have all been utilized as embolic agents [2] , [8] . When metallic coils are used, they must be tightly placed together, given the extravascular placement and lack of thrombus formation [7] .…”

Closed abdominal trauma. Liver injuries. Part 1

“…Чем тяжелее травма, тем больше вероятность осложнений. Осложнения представлены повторным внутрибрюшным кровотечением [55], внутрипеченочной гематомой, ложными артериальными и венозными аневризмами [46], гемобилией, желчным свищом [39], биломой [68], внутрипеченочным абсцессом [40] Лечение осложнений травмы печени на современном этапе развития медицины осуществляют с использованием ангиографии с эндоваскулярной эмболизацией или стентированием, пункции и дренирования под контролем УЗИ, лапароскопии, эндоскопического стентирования [69,70]. Проводить такое лечение лучше в соответствующем стационаре, куда может быть переведен пострадавший после оказания ему квалифицированной медицинской помощи и стабилизации состояния.…”