Ann Surg Treat Res.  2017 Apr;92(4):221-224. 10.4174/astr.2017.92.4.221.

Acetic acid sclerotherapy for treatment of biliary leak from an isolated right posterior sectoral duct after cholecystectomy

• Park JI
• Choi YK
• Jung BH

• KMID: 2374688
• DOI: http://doi.org/10.4174/astr.2017.92.4.221

Abstract

Bile duct injury is one of the most serious complications of both laparoscopic and open cholecystectomy. Isolated bile duct injury can occur from the misidentification of aberrant right hepatic ducts, and it is troublesome because the early diagnosis is easy to miss and the definite treatment is controversial. We report a case of an isolated right posterior sectoral duct injury following cholecystectomy managed successfully with acetic acid sclerotherapy combined with coil embolization for a fistula tract.

Keyword

Cholecystectomy; Biliary fistula; Sclerotherapy

MeSH Terms

Acetic Acid*
Bile Ducts
Biliary Fistula
Cholecystectomy*
Early Diagnosis
Embolization, Therapeutic
Fistula
Hepatic Duct, Common
Sclerotherapy*
Acetic Acid

Figure

• 

  Fig. 1 Abdomen CT scan showed complicated fluid collection in gallbladder bed.

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  Fig. 2 Percutaneous transhepatic biliary drainage cholangiogram revealed biliary leak from the right posterior sectoral duct.

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  Fig. 3 The injection of 50% acetic acid into the isolated right posterior sectoral duct was performed via a percutaneous transhepatic biliary drainage tract and was maintained for 10 minutes. The 7-F balloon occlusion catheter (Boston Scientific, Watertown, MA, USA) was used simultaneously to prevent leakage of the injected acetic acid into the fistula tract.

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  Fig. 4 Coil embolization was performed for the fistula tract between the right posterior sectoral duct and abscess cavity because of sustained biliary leakage after three sessions of acetic acid sclerotherapy.

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  Fig. 5 Abdomen CT scan taken 20 days after acetic acid sclerotherapy shows disappearance of subhepatic biloma.

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