Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement

Lorenz, Jonathan M.; Zangan, Steven; Leef, Jeffrey A.; Ha, Thuong G. Van

doi:10.1007/s00270-009-9642-3

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…However, if there is transgression of a larger central portal venous radicle-in a compromised (ie, resected, cirrhotic, or transplanted) liver especially-coil embolization of the tract (Fig 14) on either side of the transgressed vein at the time of sheath withdrawal can facilitate a tamponade of the tract and simultaneously help maintain portal venous radicle patency (23). Stent graft insertion also can be considered (24).…”

Section: Vascular Complicationsmentioning

confidence: 99%

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions

et al. 2017

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Complications related to percutaneous biliary tract interventions (PBTIs) can range from access site discomfort to life-threatening vascular complications. These complications are relatively uncommon, and most of them are self-limiting. However, major complications for which an increased level of patient care and/or a prolonged hospital stay are required and that may lead to death-albeit rarely-can occur. Some of the most common complications related to PBTI include pain, infection, bile leakage, and catheter blockage. These conditions can be easily recognized by using the patient's clinical history and laboratory examination results. However, the more uncommon complications, such as life-threatening hemobilia, acute pancreatitis, and catheter and stent fractures, may have nonspecific clinical manifestations, and the underlying pathologic condition may be found only when it is being sought specifically. It is important that diagnostic and interventional radiologists be aware of the wide spectrum of PBTI-related complications, as early recognition and treatment may prevent catastrophic situations. In addition, knowledge of the different treatment options is essential for guidance in interventional radiology procedures such as transarterial control of hemobilia, imaging-guided direct percutaneous embolization of pseudoaneurysms, and percutaneous treatment of catheter- and stent-related complications such as fractures. The authors review a wide spectrum of complications associated with PBTI and the percutaneous management of these conditions. They also highlight valuable lessons learned from morbidity and mortality rounds at a high-volume tertiary care center. RSNA, 2017.

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Section: Vascular Complicationsmentioning

confidence: 99%

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions

et al. 2017

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“…Options for treatment include catheter repositioning and replacement, catheter upsizing, and in rare cases of biliary-venous fistula, covered stent placement. 41 When internal/external PTBD is not achieved (access to small bowel fails), an external PTBD may be necessary. Potential complications of prolonged external drainage of bile include electrolyte abnormalities and malnutrition related to poor intestinal absorption.…”

Section: Percutaneous Biliary Drainagementioning

confidence: 99%

Management of Malignant Biliary Obstruction

Lorenz

2016

Semin intervent Radiol

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The diagnosis of malignant biliary obstruction combines the use of clinical evaluation, diagnostic imaging, tissue sampling, and minimally invasive options with the initial goal of identifying candidates for curative resection. The most common causes of obstruction are pancreatic adenocarcinoma and cholangiocarcinoma, and most cases are too advanced for surgical options. Interventional radiologists and gastroenterologists offer palliative options for biliary drainage such as plastic stents and catheters, bare metal stents, and covered stents. This article provides an updated review of options and outcomes for the management of malignant biliary obstruction.

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“…8 In cases of larger fistula with severe bleeding causing hemodynamic instability, immediate closure of the fistulous communication becomes necessary. 9,11 The cause of fistula in such a situation is difficult to identify as it can result from either tumor invasion or catheter erosion into the vein or both. A contrast enhanced CT scan may be performed to identify the exact cause.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Biliovenous fistula is a rare complication, seen in less than 0.5% cases, with few cases reported in literature. 4,[8][9][10][11][12] These cases are either managed conservatively or by radiological interventions in the form of balloon occlusion, coiling or covered stent placement depending on patient's hemodynamic status. 4,[8][9][10][11] We report a case of 56-year-old male with carcinoma of gall bladder, who developed bilio-venous fistula 3 weeks after PTBD and presented with features of hemodynamic shock and was managed by placement of biliary covered stent.…”

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confidence: 99%

Delayed Severe Hemobilia Due to Bilio-venous Fistula After Percutaneous Transhepatic Biliary Drainage: Treatment With Covered Stent Placement

Madhusudhan¹,

Dash

Afsan

et al. 2016

Journal of Clinical and Experimental Hepatology

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Biliovenous fistula occurs due to development of a communication between hepatic duct and portal vein branches and is a rare complication of percutaneous transhepatic biliary drainage (PTBD). Most of them are self-limiting and only occasionally they need interventional management. Placement of biliary stent graft is a viable option. We present here a case of a 56-year-old male with carcinoma of gall bladder presenting with hemodynamic shock due to severe hemobilia after PTBD and treated successfully by biliary covered stent placement. ( J CLIN EXP HEPATOL 2016;6:241-243) P ercutaneous transhepatic biliary drainage (PTBD) is a standard treatment for improvement of liver functions and relief of jaundice in patients of malignant biliary obstruction.1 The technique has a technical success rate of more than 90% and clinical success rate of more than 75%.2,3 Complications associated with the procedure are seen in about 10% of patients and severe hemorrhage is seen in about 2.3% cases. 4,5 The etiology of severe after PTBD include arterio-biliary fistula, porto-biliary fistula, pseudoaneurysms and deranged coagulation parameters.6,7 Biliovenous fistula is a rare complication, seen in less than 0.5% cases, with few cases reported in literature. 4,[8][9][10][11][12] These cases are either managed conservatively or by radiological interventions in the form of balloon occlusion, coiling or covered stent placement depending on patient's hemodynamic status. 4,[8][9][10][11] We report a case of 56-year-old male with carcinoma of gall bladder, who developed bilio-venous fistula 3 weeks after PTBD and presented with features of hemodynamic shock and was managed by placement of biliary covered stent. CASE REPORTA 56-year-old male patient presented to gastrointestinal surgery out patient clinic with history of jaundice and pain abdomen for 2 months. Clinical examination revealed icterus. Per-abdominal examination was unremarkable. Ultrasonography was done, which showed a mass replacing the gall bladder with dilatation of bilobar intrahepatic biliary ducts. Subsequently, contrast enhanced computed tomography (CT) scan was done, which showed a heterogeneously enhancing mass replacing the gall bladder and involving the primary biliary and right secondary biliary confluence and right hepatic artery. Since, the volume of segments 2 and 3 of liver was small, surgery was deferred. The patient was referred for biliary drainage. Left sided PTBD was done and an 8.3-F ring biliary catheter (Cook, Bloomington) was inserted for initial internal/external drainage. One week later, the external end of the catheter was capped to allow internal drainage of bile. After two weeks, the patient presented to the emergency department with short history of blood leaking from the sides of catheter. On examination, the patient's blood pressure was 100/76 mmHg, pulse was 112/min and respiratory rate was 12/min. His liver function tests showed total bilirubin of 4.6 mg/dL, serum albumin of 1.5 g/dL, alkaline phosphatase of 350 IU, aspartate transaminase o...

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Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement

Cited by 8 publications

References 6 publications

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions

Management of Malignant Biliary Obstruction

Delayed Severe Hemobilia Due to Bilio-venous Fistula After Percutaneous Transhepatic Biliary Drainage: Treatment With Covered Stent Placement

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