Postoperative Biliary Leak Treated with Chemical Bile Duct Ablation Using Absolute Ethanol: A Report of Two Cases

Abstract

Case seriesPatient: Female, 72 • Male, 78Final Diagnosis: Postoperative biliary leakageSymptoms: Refractory and intractable symptomsMedication: —Clinical Procedure: Chemical ablationSpecialty: SurgeryObjective:Unusual setting of medical careBackground:Postoperative bile duct leak following hepatobiliary and pancreatic surgery can be intractable, and the postoperative course can be prolonged. However, if the site of the leak is in the distal bile duct in the main biliary tract, the therapeutic options may be limited. Injection of absolute ethanol into the bile duct requires correct identification of the bile duct, and balloon occlusion is useful to avoid damage to the surrounding tissues, even in cases with non-communicating biliary fistula and bile leak.Case Report:Two cases of non-communicating biliary fistula and bile leak are presented; one case following pancreaticoduodenectomy (Whipple’s procedure), and one case following laparoscopic cholecystectomy. Both cases were successfully managed by chemical bile duct ablation with absolute ethanol. In the first case, the biliary leak occurred from a fistula of the right posterior biliary tract following pancreaticoduodenectomy. Cannulation of the leaking bile duct and balloon occlusion were achieved via a percutaneous route, and seven ablation sessions using absolute ethanol were required. In the second case, perforation of the bile duct branch draining hepatic segment V occurred following laparoscopic cholecystectomy. Cannulation of the bile duct and balloon occlusion were achieved via a transhepatic route, and seven ablation sessions using absolute ethanol were required.Conclusions:Chemical ablation of the bile duct using absolute ethanol is an effective treatment for biliary leak following hepatobiliary and pancreatic surgery, even in cases with non-communicating biliary fistula. Identification of the bile duct leak is required before ethanol injection to avoid damage to the surrounding tissues.

Biliary Ablation for Sectoral Duct Injury to Avoid Surgery

“…Those reports used various ablative materials, such as fibrin, acetic acid, ethanol, and glue. [1][2][3] The goal of ablation is to cause permanent injury of the biliary epithelium through necrosis that subsequently results in decreased biliary secretion and eventually atrophy of the affected segmental duct. Compensatory hypertrophy may ensue in the noninfused segments.…”

Endoscopic biliary ethanol ablation using a novel multi-hole balloon catheter: In vivo feasibility study in a swine model

“…The utility of ethanol ablation/injection has already been established for other diseases, including hepatocellular carcinoma [17]. Ethanol is also reportedly cytotoxic to the bile duct wall, since it causes membrane lysis and protein denaturation [18,19]. However, the method of ethanol administration and delivery method presents a hurdle while targeting the eCCA lesion.…”

“…necessary, since a certain amount of injected ethanol can flow into the intestinal tract. Occluding the duodenal papilla side with another balloon may offer a better solution to prevent the flow of ethanol into the intestinal tract while performing EA [19].…”

Microwave Ablation for Resolution of Persistent Biloma Following Hepatectomy and Cholecystectomy: Case Report

“…Ductal packing with onyx or glues has been attempted with mixed results [ 1 , 2 ]. More recently, ethanol injections have been advocated to sclerose biliary ducts [ 3 ]. Finally, ablative methods such as RFA and MWA have been used to ablate hepatic tumors and surrounding hepatic parenchyma [ 4 ].…”