Ethanol injection therapy of an isolated bile duct associated with a biliary‐cutaneous fistula

Abstract

Bile leakage after hepatic resection often results in the formation of a biliary-cutaneous fistula. Such a fistula, when caused by an isolated bile duct in the remnant liver, can be intractable. We report a successful case of ethanol injection therapy of an isolated bile duct. A 73-year-old man underwent right hepatic resection for hepatocellular carcinoma. Bile leakage occurred after surgery, and the patient developed a biliary-cutaneous fistula. Fistulography revealed an isolated bile duct in the remnant portion of the caudate lobe without communication to the main biliary system. As conservative management with simple drainage was ineffective, injection therapy with ethanol was performed with a balloon occlusion catheter. After 11 therapy sessions, the bile duct was eradicated, and the biliary- cutaneous fistula was completely healed. The post-treatment course was uneventful. Ethanol injection therapy can be a choice for management of patients with a biliary fistula caused by an isolated bile duct.

Percutaneous transhepatic portal embolization for persistent bile leakage after hepatic resection: Report of a case

“…They suggested that the most effective treatments for type D bile duct injury would be ethanol or fi brin glue injection into the divided bile duct, or reoperation. 1 We considered that our patient had a type D leak, so as a second step, we gave him ethanol injection therapy, [9][10][11] which resulted in a decrease in the amount of drained fl uid, but the bile leakage continued. Yamakado et al 12 reported successfully treating bile leakage by performing selective portal vein embolization, which induces atrophy of hepatocytes and fi brosis, whereby the embolized liver ceases to produce bile.…”

Acetic acid sclerotherapy for treatment of biliary leak from an isolated right posterior sectoral duct after cholecystectomy

“…Matsumoto et al [8] reported a successful treatment of an isolated bile duct for a biliary-cutaneous fistula case with 11 sessions of ethanol infusion. In another report by Kyokane et al [9], the isolated bile duct was treated with 6 sessions of ethanol infusion.…”

Single session of percutaneous alcohol sclerotherapy for the treatment of isolated draining intrahepatic biliary duct: case report in a 5 months-old pediatric liver transplant recipient.

“…Treatment becomes necessary in cases of isolated duct with leakage and/or external fistula when the natural evolution of the process cannot develop because continuous bile drainage is present and hepatocytes continue to produce bile. A few cases where ethanol injection therapy was used to treat an isolated bile duct with leakage and/or a biliary-cutaneous fistula have been described in adult patients (3)(4)(5). Recently, the successful treatment of a draining isolated intrahepatic biliary duct using alcohol sclerotherapy in a pediatric liver transplant recipient has been reported (6).…”