Percutaneous embolization of cystic duct stump leak following failed endoscopic management

Abstract

A case of a 79-year-old man, status post laparoscopic cholecystectomy with a drainage catheter placed at the gallbladder fossa is presented. The case was complicated postoperatively by abdominal pain and bilious discharge from the drainage catheter. Endoscopic retrograde cholangio-pancreatography demonstrated leakage through the cystic duct stump into the gallbladder fossa. Placement of a covered metal stent endoscopically failed to seal the leak. We performed percutaneous embolization of the cystic duct stump using a combination of coils and gelatin sponge through the drainage catheter in the gallbladder fossa. To our knowledge, this technique has not been previously described in the literature.

A Case of Postoperative Biliary Leak in a Patient With Duplicated Cystic Ducts

“…It is important to monitor patients postoperatively for bile leak, even if biliary injury was found and treated intraoperatively [4]. A common treatment for postoperative bile leak is ERCP with stent placement, which helps facilitate bile flow, allowing passive leak healing [5,6,8]. If an endoscopic intervention fails, percutaneous intervention, such as external biliary drain placement, can be performed [5,[8][9][10].…”

“…A common treatment for postoperative bile leak is ERCP with stent placement, which helps facilitate bile flow, allowing passive leak healing [5,6,8]. If an endoscopic intervention fails, percutaneous intervention, such as external biliary drain placement, can be performed [5,[8][9][10]. Alternative options, such as cystic duct embolization with vascular coils and micropledgets, have been proposed when direct access to the biliary leak is available [5,8,10].…”

“…If an endoscopic intervention fails, percutaneous intervention, such as external biliary drain placement, can be performed [5,[8][9][10]. Alternative options, such as cystic duct embolization with vascular coils and micropledgets, have been proposed when direct access to the biliary leak is available [5,8,10]. Complications of these minimally invasive procedures include but are not limited to infection, duct perforation, hemorrhage, or stent/drain displacement.…”

Preventive Transhepatic Tract Embolisation after Percutaneous Biliary Interventions: A Systematic Review

“…The principle of vascular coil embolisation is vascular occlusion with subsequent vascular thrombosis and may work in the transhepatic tract concerning bleeding but may be questionable concerning bile fluid. Therefore, coils were combined with gelatin or cyanoacrylate for embolisation of large bile duct fistula in some case reports that were not included in this analysis [ 24 – 26 ]. Furthermore, it must be kept in mind that coil migration may occur months later after embolisation [ 27 ].…”