Bilio-cutaneous fistula obliteration with NBCA

Abstract

Biliary fistula and bile leakage are complications that can occur during hepato-biliary surgery (both open and laparoscopic) and percutaneous biliary intervention. In some cases, spontaneous resolution is documented but more often re-intervention (surgical or percutaneous) is necessary. We present the case of a male patient who underwent right hepatectomy with bilio-digestive anastomosis for a cholangiocarcinoma which developed a bilo-cutaneous fistula through the path of a previously inserted percutaneous transhepatic drainage. Sealing of bilo-cutaneous fistula was obtained using N-butil-Cyanoacrylate. This technique has already been reported in some papers as a useful tool for biliary tree obliteration; however, to our knowledge, no cases describing the use of glue to seal a sub-cutaneous route are available in literature.

Combined Bile Duct Ablation and Fistulous Tract Embolization Using N-Butyl Cyanoacrylate to Manage a Biliary-Cutaneous Fistula Following Percutaneous Transhepatic Biliary Drainage (PTBD) for Hilar Cholangiocarcinoma

“…While most of the cases were due to ruptured hepatic abscesses following tumor ablation, one patient had developed a biliary fistula after pancreatitis. 1 Bottari et al 4 and Alberto et al 5 performed successful obliteration of a BCF using glue. Furthermore, Ierardi et al demonstrated successful treatment of a BCF following the removal of a PTBD catheter using an Amplatzer vascular plug.…”

Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report

“…In our case, we injected NBCA glue to fill the fistula cavity, followed by placing micro-coils to occlude the leaking bile duct. In literature review, 4 cases of biliocutaneous fistulas successfully sealed by interventional radiologic management have been reported [ 4 , 8 , 9 ]. The causes of such fistulas formation include Whipple operation for pancreatic tumor, hepatic surgery for hydatid disease, and prolonged percutaneous biliary drainage.…”

Interventional Radiological Management and Prevention of Complications after Pancreatic Surgery: Drainage, Embolization and Islet Auto-Transplantation

“…The use of retrievable covered stents is gaining a foothold in the last years, accordingly to numerous studies, with a high rate of clinical success, providing an effective and definitive treatment [ 55 ]. On the other hand, other options which may be taken in consideration are the employment of balloon occlusions [ 46 ] or embolizing materials, such as fibrin, coils, and acetic acid, with an increased use of the N-butyl cyanoacrylate, according to the literature [ 56 , 57 , 58 ].…”