Clin Endosc.  2023 May;56(3):384-387. 10.5946/ce.2022.098.

Percutaneous creation of a choledocho-choledochostomy for intractable iatrogenic bile duct injury

• Dai R
• Kim CY
• Sudan DL
• Perkins SS
• Tamas JW
• Suhocki PV

• KMID: 2542467
• DOI: http://doi.org/10.5946/ce.2022.098

Figure

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  Fig. 1. Coronal reconstruction of computerized tomography with iodinated intravenous contrast demonstrates a large, cavernous hemangioma of the liver prior to extended right partial hepatectomy.

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  Fig. 2. (A) Contrast injection of the surgical drain (arrowheads) post-operatively reveals a large biloma (black arrow) communicating with the left biliary tree. The tip of the endoscopically placed biliary stent (open arrow) is located in the stump of the left main bile duct. (B) Endoscopic retrograde cholangiopancreatography demonstrates the common hepatic duct (black arrow) and the stump of the left main bile duct (open arrow). The percutaneous biliary drainage catheter (arrowheads) lies within the left biliary tree and terminates in the biloma. (C) Contrast injection of the left biliary tree reveales the isolated left main bile duct (black arrow) terminating at the surgical staple line. The surgical drain was replaced with a 16 French straight drainage catheter (open arrow).

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  Fig. 3. (A) Digitally subtracted portal venogram through a percutaneous 3 French catheter (arrowheads) demonstrates the safe distance between the left main portal vein and the planned trajectory of the radiofrequency PowerWire (Baylis Medical, black arrow) in the isolated left biliary tree and the nasobiliary drain (open arrow) in the left main duct stump. A safe distance from the hepatic artery was confirmed on the arterial phase of computed tomography with iodinated contrast. (B) The radiofrequency PowerWire (black arrows) passes from the excluded left biliary tree to the stump of the left main duct, opacified with iodinated contrast injected through a nasobiliary drain (open arrow). A 3 French catheter lies within the left portal venous system. (C) A 10 French percutaneous biliary drainage catheter passes from the left biliary tree through the newly created choledocho-choledochostomy (black arrows) and into the duodenum.

Reference

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