Ann Hepatobiliary Pancreat Surg.  2021 Aug;25(3):386-389. 10.14701/ahbps.2021.25.3.386.

Percutaneous trans-hepatic rescue and neo-creation of a post-surgical complete hepaticojejunostomy dehiscence

• Rossi UG
• DeCensi A
• Rollandi GA
• Filauro M

• KMID: 2519296
• DOI: http://doi.org/10.14701/ahbps.2021.25.3.386

Abstract

Biliary leakage complicating hepaticojejunostomy is a therapeutic dilemma for surgeons, gastroenterologist, and interventional radiologist. It is a major cause of postoperative morbidity. Percutaneous biliary intervention techniques have been developed for treating benign post-surgical biliary disease in patients not having severely compromised clinical conditions. Interventional radiology manoeuvres are especially indicated as the first line of treatment if endoscopic procedures are unfeasible for patients due to postsurgical anatomical modifications. We present a case of post-surgical complete hepaticojejunostomy dehiscence that was treated totally by percutaneous techniques with trans-hepatic rescue and hepaticojejunostomy neo-creation.

Keyword

Biliary; Interventional radiology; Drainage; Surgery; Liver

Figure

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  Fig. 1 Multi-detector computed tomography axial image demonstrating a perihepatic collection (*) with air bubbles at the level of hepaticojejunostomy (arrowhead).

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  Fig. 2 Percutaneous catheter contrast study done from surgical drains (arrows) showing a collection of contrast medium (*) that leaks from the hepaticojejunostomy complete dehiscence. Retrograde opacification of not dilated intra-hepatic biliary was noted (arrowhead). Note that there was no opacification of the anastomotic bowel loop.

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  Fig. 3 Percutaneous trans-hepatic cholangiography from internal-external biliary drainage (arrowhead) with its tip inserted into the anastomotic bowel loop (#). Note the persistent collection of contrast medium (*) from the hepaticojejunostomy complete dehiscence.

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  Fig. 4 Percutaneous trans-hepatic cholangiography from internal-external biliary drainage (arrowhead) at one month with regular flow of bile from the liver to the bowel (#). Note the absence of contrast medium collection and creation of a neo-hepaticojejunostomy that appears stenotic (arrow).

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  Fig. 5 Percutaneous trans-hepatic cholangiography from the external introducer (arrowhead) that shows a regular diameter of the neo-hepaticojejunostomy (arrow) after bioresorbable stent deployment with regular floe to the bowel (#).

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  Fig. 6 Coronal computed tomography image at follow-up that confirms a regular diameter of the neo-hepaticojejunostomy (arrow) between the liver (*) and the bowel (#).

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