Combined Interventional Radiological and Endoscopical Approach for the Treatment of a Postoperative Biliary Stricture and Fistula

摘要

A 43-year old woman was admitted 11 days after open cholecystectomy with a iatrogenic bileduct injury. On admission the patient showed an uncontrolled biliary fistula through an externaldrain placed at an emergency laparotomy for biliary peritonitis with fever and jaundice. PTCshowed a biliary stricture type II (Bismuth). A percutaneous drainage was performed todecompress the biliary system. Three weeks later, percutaneous balloon dilatation of thestricture was performed. However, bile leakage persisted. In a combined transhepatic/endoscopic procedure, the percutaneous biliary drainage was replaced by a nasobiliary tube.One week later, no stricture was found and the biliary leak was sealed. The patient could bedischarged without symptoms or signs of cholestasis. The multidisciplinary management ofpost-operative biliary fistula is presented, comparing the role of interventional radiology,endoscopy and surgery.