Bile duct reconstruction with single-operator cholangioscopy and percutaneous radiological rendezvous procedure
Intrahepatic bile leaks secondary to disconnected hepatic segments following liver resection can be difficult to treat . There are only isolated reports of successful endoscopic management  . We present the case of a 41-year-old woman with colorectal cancer and hepatic secondaries who received a segment IVb liver resection and multisegment microwave ablation. Surgery was complicated by biliary sepsis and a large biliary leak. Baseline cross-sectional imaging and endoscopic retrograde cholangiopancreatography (ERCP) established the presence of a surgically clipped left hepatic duct and disconnected left lobe leaking into an intrahepatic cavity ([Fig. 1]). Left-sided percutaneous transhepatic biliary drainage (PTBD) was performed and then, under direct cholangioscopic guidance (SpyGlass DS direct visualization system; Boston Scientific, Marlborough, Massachusetts, USA), the occluded left hepatic duct was dilated and the cavity accessed ([Video 1]).
Video 1 Bile duct reconstruction with single-operator cholangioscopy and percutaneous radiological rendezvous procedure following partial hepatectomy complicated by disconnected biliary system and bile leak.
A rendezvous procedure via the percutaneous transhepatic biliary drain allowed an intracavity guidewire to be cholangioscopically snared and the biliary tree reconstructed by endoscopic placement of bilateral fully covered metal stents ([Fig. 2]). The bile leak rapidly resolved with reconstitution of the biliary system.
Reconstitution of a disconnected intrahepatic biliary tree is challenging, but in this case successful management was achieved by (1) radiologic access to the disconnected biliary tree with an external drain and (2) cholangioscopic access to the cavity via the occluded left hepatic duct with direct retrieval of the radiologically placed guidewire and stenting. The management of a disconnected biliary system may be aided by cholangioscopy-guided therapy.
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
19 June 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Honoré C, Vibert E, Hoti E. et al. Management of excluded segmental bile duct leakage following liver resection. HPB (Oxford) 2009; 11: 364-369
- 2 Yoshida M, Morimoto M, Kato A. et al. Recanalization of postoperative biliary disconnection with intraductal cholangioscopy-assisted forceps retrieval of rendezvous guidewire. Endoscopy 2018; 50: E338-E339
- 3 Bukhari MA, Haito-Chavez Y, Ngamruengphong S. et al. Rendezvous biliary recanalization of complete biliary obstruction with direct peroral and percutaneous transhepatic cholangioscopy. Gastroenterology 2018; 154: 23-25