Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

Abstract

Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Cystic duct is the most common site of bile leak after cholecystectomy. The treatment of choice is usually conservative. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful. We report a technique for the successful treatment of persistent cystic duct leak. After failed ERCP and stenting, bile leak was treated by coiling the cystic duct through a drain tract. This technique is safe and effective and helps avoid the morbidity of reoperation.

Subvesical Duct Detected by Magnetic Resonance Cholangiopancreatography (MRCP) in a Patient with Bile Leak after Laparoscopic Cholecystectomy

“…Several studies mentioned that more than 90% of bile leaks will resolve after ERCP treatment. [5][6][7] Most cases of bile leak due to subvesical duct injury can be successfully managed by ERCP with or without sphincterotomy plus stent insertion. The management mentioned above is usually to treat the bile leak that the amount is more than 200 ml per day.…”

“…The management mentioned above is usually to treat the bile leak that the amount is more than 200 ml per day. [5][6][7][8] For the cases with smaller amount of bile leak, with a drain placed during LC, spontaneous closure takes about 6-8 weeks.…”

“…Distal stent migration is rarely complicated with perforation, but surgery is needed if it occurrs. [6][7][8][9][10] Therefore, if there are symptoms and signs like cholangitis after CBD stent insertion, ERCP is the only way to identify the causes of the complication after stenting.…”

Case of bile duct coil embolization for broncho‐biliary fistula after radiofrequency ablation (with video)

“…Although the ENBD tube was placed and reoperation was considered, reoperation at the same site was considered difficult. Because the quality of life with an external fistula is markedly reduced, we decided to use coil embolization to block the bronchial duct that communicated with the bronchi 1 . After referring to previously reported treatments, a 4.5‐Fr ERCP catheter (Glo‐tip ERCP catheter; Cook Medical, Bloomington, IN, USA) was inserted in the target bile duct (B7, B8) and 0.035‐inch 26 mm coils (Tornado Embolization Coil; Cook Medical) were extruded from the catheter using 0.035‐inch guidewire (Jagwire; Boston Scientific, Marlborough, MA, USA) and placed in the bile duct (Video S1).…”

“…(b) After the coil was placed, contrast injection confirmed the disappearance of the contrast medium leak from the bile duct communicated with the bronchi. 1 After referring to previously reported treatments, a 4.5-Fr ERCP catheter (Glo-tip ERCP catheter; Cook Medical, Bloomington, IN, USA) was inserted in the target bile duct (B7, B8) and 0.035-inch 26 mm coils (Tornado Embolization Coil; Cook Medical) were extruded from the catheter using 0.035-inch guidewire (Jagwire; Boston Scientific, Marlborough, MA, USA) and placed in the bile duct (Video S1). [2][3] We performed contrast every time the coil was placed.…”