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08 August 2017 : Case report  Japan

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

Unusual setting of medical care

Maho Sasaki1BDEF, Tomohide Hori1ACDEF*, Hiroaki Furuyama1ABDF, Takafumi Machimoto1BF, Toshiyuki Hata1BF, Yoshio Kadokawa1BF, Tatsuo Ito1BF, Shigeru Kato1BF, Daiki Yasukawa1BF, Yuki Aisu1BF, Yusuke Kimura1BF, Yuichi Takamatsu1BF, Taku Kitano1F, Tsunehiro Yoshimura1ADF

DOI: 10.12659/AJCR.905093

Am J Case Rep 2017; 18:871-877

Abstract

BACKGROUND: 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.

Keywords: Bile, Ethanol, Postoperative Complications

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923