A Case of Major Bile Leak after Laparoscopic Cholecystectomy Successfully Treated by Biliary Ablation with Absolute Ethanol

Abstract

F i g. 2 Ab d o mi n a l C T, o n p o s t o p e r a t i v e d a y 6 , r ev e a l e d i n t r a-a b d o mi n a l f l u i d c o l l e c t i o n .

Intraoperative Bile Duct Disruption Treated Using Intrahepatic Biliary Ablation with Ethanol: A Report of Two Cases

“…As a result, bile leakage can be stopped; however, repeated ethanol injections are usually required. In previous reports, 1-4 ethanol injections were administered in one session, and 4-19 sessions were performed at 1-3-day intervals [4,5]. We continuously injected ethanol thrice, and bile leakage could be stopped in a single session.…”

“…In a report by Ito et al [5], however, ethanol was also injected through a 21-gauge needle after a percutaneous direct puncture of the target bile duct in three of 31 patients when a drainage catheter could not be advanced into it. The inflation time of the balloon has not been standardized and varies from 5 minutes to 24 hours [4,5]. We performed overnight inflation in case 1; however, it remains uncertain whether or not this is effective.…”

“…Since ethanol is not radiopaque, it is impossible to observe its distribution directly. Therefore, a test injection of the contrast material is required to determine the optimal ethanol volume [4,5]. We mixed iodized oil with ethanol to render the mixture radiopaque.…”

“…However, for a leaking bile duct without a fistula communicating it to the CBD, such as a disrupted bile duct, percutaneous interventions are mainly performed [2]. Although a standard treatment for the disrupted bile duct has not been established, usefulness of intrahepatic biliary ablation with ethanol for refractory bile leakage has been reported [4,5]. We encountered two cases of bile leakage due to intraoperative bile duct disruption successfully treated with intrahepatic biliary ablation.…”