Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(3) > 1040549

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Kim, Kim, Yun, Ham, Kim, Jeong, Kim, Jung, Lee, and Hong: Segmental bile duct leakage after hepatic resection managed with percutaneous ablation by N-butyl cyanoacrylate
Case Report
Korean Journal of Hepato-Biliary-Pancreatic Surgery

Korean Journal of Hepato-Biliary-Pancreatic Surgery 2012; 16(3): 115-119.

Published online: 31 August 2012

DOI: https://doi.org/10.0000/kjhbps.2012.16.3.115

Segmental bile duct leakage after hepatic resection managed with percutaneous ablation by N-butyl cyanoacrylate

Hyeon Sik Kim1, Tae Hyo Kim1, 3, Eun Young Yun1, Hyun Seok Ham1, Hong Jun Kim1, Chi-Young Jeong2, Hyun Jin Kim1, Woon Tae Jung1, Ok-Jae Lee1, Soon-Chan Hong2

1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

2Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea.

3Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.

Corresponding author: Tae Hyo Kim. Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, 90, Chilam-dong, Jinju, 660-702, Korea. Tel: +82-55-750-8726, Fax: +82-55-758-9122, kimthy@medimail.co.kr

Received 20 June 2012       Revised 25 July 2012       Accepted 30 July 2012

Copyright © 2012 Korean Association of HBP Surgery

Abstract

A biloma is a rare abnormal accumulation of intrahepatic or extrahepatic bile caused by a traumatic or spontaneous rupture of the biliary tree. The reported incidence of postoperative biloma ranges from 4.8% to 7.6%. Biliary drainage is usually important and necessary for the treatment of biloma, but sometimes bile leakage fails to improve despite prolonged conservative drainage. We report a case of postoperative refractory biliary leakage managed with percutaneous ablation by N-butyl cyanoacrylate.

Keywords: Biloma, Biliary leakage, N-butyl cyanoacrylate

Figures and Tables

kjhps-16-115-g001
Fig. 1
Postcontrast abdominal computed tomography shows a large intrahepatic fluid collection at the resected bed.

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Fig. 2
Fluoroscopic spot film of a tube cholangiogram demonstrating contrast (bile) extravasation (bile leak site; open arrow) from a dehisced isolated right intrahepatic bile duct segment (arrow). An adjacent biloma is seen with a drain in it.

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Fig. 3
Image obtained during an N-butyl cyanoacrylate (glue) injection for ablating a fistula. It shows obliteration of the communication between the biloma and the bile duct.

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Fig. 4
Follow-up contrast-enhanced computed tomography image demonstrating the hardened N-butyl cyanoacrylate casting the ablated right intrahepatic bile duct. Marked decrease in the size of the biloma is shown.

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References

1. Fujiwara H, Yamamoto M, Takahashi M, et al. Spontaneous rupture of an intrahepatic bile duct with biloma treated by percutaneous drainage and endoscopic sphincterotomy. Am J Gastroenterol. 1998. 93:2282–2284.
2. Jun KH, Cho HM, Chin HM, et al. A nontraumatic rupture of intrahepatic bile duct and perihepatic biloma formation in a patient with choledocholithiasis: a case report. Korean J Hepatobiliary Pancreat Surg. 2004. 8:46–49.
3. Park JH, Oh JH, Yoon Y, et al. Acetic acid sclerotherapy for treatment of a biliary leak from an isolated bile duct after hepatic surgery. J Vasc Interv Radiol. 2005. 16:885–888.
4. Ota T, Hirai R, Tsukuda K, et al. Biliary reconstruction with right hepatic lobectomy due to delayed management of laparoscopic bile duct injuries: a case report. Acta Med Okayama. 2004. 58:163–167.
5. Mueller PR, Ferrucci JT Jr, Simeone JF, et al. Detection and drainage of bilomas: special considerations. AJR Am J Roentgenol. 1983. 140:715–720.
6. Binmoeller KF, Katon RM, Shneidman R. Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol. 1991. 86:227–231.
7. Vazquez JL, Thorsen MK, Dodds WJ, et al. Evaluation and treatment of intraabdominal bilomas. AJR Am J Roentgenol. 1985. 144:933–938.
8. Lee JH, Suh JI. A case of infected biloma due to spontaneous intrahepatic biliary rupture. Korean J Intern Med. 2007. 22:220–224.
9. Akhtar MA, Bandyopadhyay D, Montgomery HD, et al. Spontaneous idiopathic subcapsular biloma. J Hepatobiliary Pancreat Surg. 2007. 14:579–581.
10. Geenen JE, Toouli J, Hogan WJ, et al. Endoscopic sphincterotomy: follow-up evaluation of effects on the sphincter of Oddi. Gastroenterology. 1984. 87:754–758.
11. Hartle RJ, McGarrity TJ, Conter RL. Treatment of a giant biloma and bile leak by ERCP stent placement. Am J Gastroenterol. 1993. 88:2117–2118.
12. Saad WE, Darcy MD. Percutaneous management of biliary leaks: biliary embosclerosis and ablation. Tech Vasc Interv Radiol. 2008. 11:111–119.
13. Kyokane T, Nagino M, Sano T, et al. Ethanol ablation for segmental bile duct leakage after hepatobiliary resection. Surgery. 2002. 131:111–113.
14. Vu DN, Strub WM, Nguyen PM. Biliary duct ablation with N-butyl cyanoacrylate. J Vasc Interv Radiol. 2006. 17:63–69.
15. Tanaka S, Hirohashi K, Tanaka H, et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg. 2002. 195:484–489.
16. Bhattacharjya S, Puleston J, Davidson BR, et al. Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endosc. 2003. 57:526–530.
17. Wright G, Jairath V, Reynolds M, et al. Endoscopic glue injection for persistent biliary leakage. Gastrointest Endosc. 2009. 70:1279–1281.
18. Seewald S, Groth S, Sriram PV, et al. Endoscopic treatment of biliary leakage with n-butyl-2 cyanoacrylate. Gastrointest Endosc. 2002. 56:916–919.
19. Tomazic A, Mlinaric V, Pleskovic A. Ascending venous thrombosis from the middle hepatic vein to the left pulmonary artery as a complication of endoscopic Histoacryl sealing of a bile leak after blunt liver injury. Endoscopy. 2006. 38:Suppl 2. E8–E9.
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