Endoscopic Management of a Post-traumatic Biliary Fistula

Abstract

A number of techniques of surgical endoscopy have been used in the management of a post-traumatic biliary fistula. The endoscopic sphincterotomy with placement of a perfused nasobiliary catheter, followed by the insertion of a biliary stent allowed the fistula to dry out. A secondary stricture of the left hepatic duct was treated by endoscopic internal drainage after the insertion of a transhepatic guidewire by an epigastric route. This kind of combined transhepatic and endoscopic procedure is useful in some difficult cases.

Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks

“…One alternative to stent placement is the use of a nasobiliary tube [2,5,9,22]. These tubes can be removed without a repeat endoscopy, although a follow-up cholangiogram is usually performed.…”

Endoscopic Biliary Drainage of Postoperative Biliary Fistulae and Leak

“…Percutaneous transhepatic drainage has been attempted in the treatment of bile duct fistulae [3]. During the last few years, successful endoscopic management of postoperative biliary fistulae have been reported [4][5][6][7][8][9][10]. The majority of these cases have been associated with retained bile duct stones obstructing the distal biliary tree [2,3].…”