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DOI: 10.1055/a-2241-1656
Infected percutaneous transhepatic cholangiography catheter and rescue hepaticogastrostomy in patient with gallbladder carcinoma
We present the case of a 58-year-old man with stage IV gallbladder carcinoma. The metastases of the liver caused obstructive jaundice, and due to the choledochal, cystic, and intrahepatic biliary duct metastases, endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful. Therefore, percutaneous transhepatic cholangiography (PTC) was performed.
The patient attended the oncology clinic because he had experienced several suppurative cholangitis episodes in the previous 4 months. The decision to remove the PTC catheter was related to erythema, swelling, and green-bluish suppurative biliary discharge due to Pseudomonas infection.
The computed tomography (CT) scan following intravenous contrast administration revealed multiple biliary tree metastases and an enlarged left intrahepatic biliary duct. Endoscopic ultrasound (EUS) (GF-UCT160-OL5, Olympus, Tokyo, Japan) guided the hepaticogastrostomy procedure, which was started in the biliary duct in segment II. After confirming the insertion of the biliary tree with bile drainage in the injector, a path was created, aided by a 6 Fr cystotome (Endo-Flex GmbH, Voerda, Germany), and a 7 Fr × 10 cm biliary pigtail stent (Endo-Flex GmbH, Voerda, Germany) was placed. The procedure was successful ([Video 1]). The PTC catheter was removed after the procedure, and adequate antibiotic therapy with meropenem and vancomycin was prescribed for a week.
Endoscopic ultrasound-guided hepaticogastrostomy for rescuing an infected percutaneous transhepatic cholangiography catheter.Video 1The biliocutaneous fistula from the PTC catheter line spontaneously closed 1 week after removal of the catheter. No complications related to hepaticogastrostomy or jaundice were observed during the 2-month follow-up period.
If the standard ERCP fails, especially for malignant diseases, EUS-guided puncture from the stomach to the biliary ducts can be performed for biliary drainage [1] [2]. PTC could also be performed, although it increases susceptibility to infection. The biliocutaneous tracts associated with the infected PTC line spontaneously closed after antibiotic treatment and adequate biliary drainage from the hepaticogastrostomy [3].
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Publication History
Article published online:
07 February 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: 35
- 2 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 54: 185-205
- 3 Saka D, Barbur E, Boynukara C. et al. Endoscopic ultrasound-guided hepatogastrostomy to treat a biliocutaneous fistula. Endoscopy 2020; 52: E315