Postoperative Biliocutaneous Fistula: Successful Treatment by Insertion of an Endoprosthesis

Steenbergen, Werner Van; Haemers, A.; Pelemans, Walter; Ponette, E; Vanwing, Jacques; Verbeken, Erik; Fevery, Johan

doi:10.1055/s-2007-1018224

Cited by 9 publications

(1 citation statement)

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“…Most spontaneous biliary fistulae are internal (cholecystoduodenal). External biliary fistula is a rare problem that usually results from a bile duct injury, undetected distal biliary obstruction, or breakdown of a biliary anastomo-sis (3,4). Typically, the fistulae arise from extrahepatic ducts and rarely communicate with the IHD.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous External Biliary Fistula: A Rare Complication of Cholangiocarcinoma

Song

Hyuk

et al. 2011

Intern. Med.

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A 68-year-old woman presented with yellowish discharge oozing from a fistula opening in the upper epigastric area that had persisted for one month prior to her visit. The patient had undergone a left lateral segmentectomy of the liver ten years prior for treatment of intrahepatic duct (IHD) stones. An abdominal computed tomography (CT) scan showed focal stricture and proximal dilatation of remnant IHD and a 1 cm-sized rim-enhancing lesion located under the surgical bed of the abdominal wall surrounding the dilated remnant IHD. Despite conservative management including nasobiliary drainage, no further improvement was anticipated. Partial hepatectomy and fistulectomy were performed for pathologic diagnosis and treatment of the enhancing lesion. Histopathology revealed adenocarcinoma. In this case, cholangiocarcinoma might have arisen in association with IHD stones and then developed a choledocho-cutaneous fistula as a clinical manifestation.

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Section: Discussionmentioning

confidence: 99%

Spontaneous External Biliary Fistula: A Rare Complication of Cholangiocarcinoma

Song

Hyuk

et al. 2011

Intern. Med.

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Histologic Changes After Stenting of the Pancreatic Duct

Álvarez

Robert

Sherman³

et al. 1994

Arch Surg

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The placement of stents has been proposed as a possible modality to treat pancreatic diseases. Ductal changes observed on endoscopic retrograde cholangiopancreatography during stenting are believed to be reversible when the stents are removed. We describe a patient with normal anatomy on baseline pancreatograms who underwent endoscopic sphincterotomy, followed by stent placement for 9 months. Symptoms progressed, leading to a pancreaticoduodenectomy. Histologic evaluation of the head of the pancreas revealed more extensive inflammatory changes in the duct and parenchyma drained by the stent. This suggests that stent-induced changes noted on pancreatography correspond to parenchymal changes that may be severe and irreversible.

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Treatment of a postoperative cholecystocutaneous fistula by an endoscopic stent

Sedgwick

Denyer

1989

British Journal of Surgery

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measured 17 x 8 cm and the weight-bearing area of the calcaneum was exposed. Owing to the size and depth of the ulcer, full-thickness tissue replacement was felt to be necessary. Local flaps were small and the vascular supply in doubt; therefore, a free vascularized radial forearm flap was planned.Five weeks after the vascular reconstruction the ulcer was stable and arteriography confirmed a patent graft with filling of the anterior tibial vessels.A left radial forearm flap, 18 x 9 cm, was raised, and transferred to the right heel. An end-to-side anastomosis was performed between the radial artery and the dorsalis pedis artery, and end-to-end anastomoses were performed with both venae communicantes, using microsurgical techniques.One month later the flap was trimmed and inset. Healing was complete at 6 weeks and the patient could be mobilized, taking full weight on his heel.After 5 months the vascular graft was still patent and the foot, including the heel flap, was healthy and pain free ( Figure I). While the patient was being investigated for severe claudication in his other leg, the arteriogram shown in Figure 2 was obtained. This shows the PTFE graft to the posterior tibial artery supplying the foot vessels and from these the dorsalis pedis artery from which the skin flap artery takes origin. DiscussionA functioning vascular graft is of no value if the patient cannot walk on the salvaged foot. In our experience, patency rates of 90 per cent at 1 year can be obtained using externally supported PTFE prosthetic grafts to a suitable tibial or peroneal vesselCase reports provided that vein patches are incorporated in the anastomoses. The patch may be beneficial in reducing the compliance mismatch between prosthesis and artery, perhaps leading to increased flow, and reducing the severity of intimal hyperplasia. We believe that, in the absence of severe established gangrene, amputation should never be performed without first exploring the tibial vessels. As this case demonstrates, the arteriogram may not always give a true picture of the distal vessels. Even so, until recently this man's foot would have been regarded as unsalvageable as traditional skin grafts are not sufficiently robust to cover exposed bone on a weight-bearing area.The free-flap technique provides substantial skin cover of even large areas of exposed bone without lengthy immobilization. The best source vessel in the foot is the anterior tibial as it is superficially situated and therefore accessible for the end-to-side placement of a 'wrap-around' graft for heel or sole. In our patient, even though the vascular graft was to the posterior tibial, the collateral flow to the dorsalis pedis artery was sufficient to support the flap.In conclusion, the development of free-flap grafts means that extensive heel-pad necrosis should no longer be regarded as an indication to amputate. A distal vascular reconstruction which is successful in salvaging the rest of the foot can support a free-flap skin/muscle graft. Gallstone retention and external biliary fistu...

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Postoperative Biliocutaneous Fistula: Successful Treatment by Insertion of an Endoprosthesis

Cited by 9 publications

References 0 publications

Spontaneous External Biliary Fistula: A Rare Complication of Cholangiocarcinoma

Spontaneous External Biliary Fistula: A Rare Complication of Cholangiocarcinoma

Histologic Changes After Stenting of the Pancreatic Duct

Treatment of a postoperative cholecystocutaneous fistula by an endoscopic stent

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