Percutaneous creation of a hepaticojejunostomy

Percutaneous Hepaticojejunostomy Using a Radiofrequency Wire for Management of a Postoperative Bile Leak

Postoperative biliary complications following extensive hepatic resections are complex, often requiring a multidisciplinary team approach. We describe a case of a free bile duct leak following extended right hepatectomy and surgical hepaticojejunostomy treated with percutaneous transhepatic hepaticojejunostomy in which a radiofrequency guidewire was used to gain enteral access. A modified internal/external biliary catheter was left in place. The patient was enrolled in a benign biliary stricture protocol, and 8 months later, the catheter was removed following a normal cholangiogram and biliary manometric perfusion testing. At 3-month follow-up after catheter removal, the patient is asymptomatic with no clinical, biochemical, or radiographic evidence of biliary leak or obstruction.

Retrograde Percutaneous Transjejunal Creation of Biliary Neoanastomoses in Patients with Complete Hepaticojejunostomy Dehiscence

A technique of percutaneous hepaticojejunostomy (PHJ) was developed to allow creation of a neoanastomosis in cases of hepaticojejunostomy (HJ) dehiscence when endoscopic intervention is unfeasible as a result of postsurgical anatomy. PHJ involves transhepatic biliary catheterization and transjejunal retrograde enterotomy. A rendezvous establishes the communication between the bile ducts and the jejunum. PHJ was performed in five patients, and neoanastomosis creation without residual biliary leak was achieved in all cases, with no procedure-related complications. Bilirubin levels and white blood cell counts quickly decreased after PHJ (median, 1 d; range, 1-4 d). Median survival after PHJ was 210 days (range, 45-540 d).

Percutaneous hepaticojejunostomy with use of a metal stent for injury of the right hepatic duct after laparoscopic cholecystectomy

Bile-duct injuries related to laparoscopic cholecystectomy may be complex and require a multidisciplinary approach. The authors report a case of a high hepatic duct injury treated surgically by a left hepaticojejunostomy and an ischemic right hepatic duct that could not be identified during the operation. The right hepatic lobe was subsequently drained radiologically by the percutaneous creation of a right hepaticojejunostomy, through and into a jejunal access loop, followed by deployment of a metallic stent. The patient remained well at 3-year follow-up.

Obstruction of the Roux limb after portoenterostomy for biliary atresia: a delayed complication

We report the case of a 5-year-old girl who underwent a Kasai portoenterostomy for extrahepatic biliary atresia. The conduit was exteriorized until 11 months of age. She was doing well, with stable portal hypertension until she suddenly developed jaundice, acholic stools, and bacteremia not responsive to a course of steroids and intravenous antibiotics. Suspecting obstruction at the site of the previously exteriorized anastomosis, a percutaneous cannulation of the conduit was performed. Catheterization of the conduit obstruction unkinked it and reestablished bile flow. She has remained anicteric with stable liver function.