Coil migration into the common bile duct as a cause of cholangitis

Endoscopic Coil Embolization for Refractory Intrahepatic Biliary Duct Leak

Bile leaks may be seen after blunt and penetrating trauma, as well as iatrogenic injury from surgical procedures. There are many articles on endoscopic treatment options for the management of biliary leaks, including sphincterotomy, endoscopic stent, or nasobiliary drain placement. Data, however, are scarce regarding the management of persistent biliary leaks after the initial intervention. We present a case of endoscopic coil embolization to treat a refractory bile leak after initial endoscopic sphincterotomy and stent placement in a patient with a grade IV liver laceration due to a gunshot wound.

Feasibility of Mynxgrip®-Assisted Percutaneous Transhepatic Portal Venous Access Closure

PURPOSE

Life-threatening bleeding may occur following percutaneous portal venous access procedures. Various embolic agents have been utilised to minimise this risk, each with their own disadvantages, including inadvertent embolization of the portal vein and inadequate tract embolization. We aim to assess the feasibility of a novel approach to percutaneous portal venous access closure by utilising the MYNXGRIP® vascular closure device (Cardinal Health, USA).

MATERIALS AND METHODS

This retrospective study analysed 20 patients who underwent interventional radiological procedures with closure of the percutaneous transhepatic portal venous access tract using the MYNXGRIP® closure device with either N-butyl cyanoacrylate or thick gelatin paste.

RESULTS

None of these patients demonstrated clinical evidence of post-procedural haemorrhage, which was further confirmed on abdominal imaging in 15 of these patients.

CONCLUSION

MYNXGRIP®-assisted percutaneous transhepatic portal venous access closure is feasible and able to achieve haemostasis with minimal embolization risk.

Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature

Background

Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies.

Case presentation

We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis.

Conclusion

The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.

A novel endoscopic treatment of major bile duct leak

INTRODUCTION

Bile leak is a serious complication of hepatobiliary surgery. The incidence has remained the same over the last decade despite significant improvement in the results of liver surgery.

PRESENTATION OF CASE

A 21-year-old man was a passenger in a motor vehicle and sustained a blunt abdominal trauma in a high-speed collision leading to major liver laceration. He had right lobe hepatectomy complicated by major bile leak. He was not fit for further surgery and he, therefore, had ERCP and obliteration of the leaking bile duct using a combination of metallic coil and N-butyl cyanoacrylate.

DISCUSSION

Endoscopic therapy has become the modality of choice in the treatment of biliary tract injuries. Different modalities of management of persistent bile leak such as sphincterotomy, plastic biliary stents, and nasobiliary drainage have been described. Obliteration of bile duct leak using N-butyl cyanoacrylate and coil embolization has been described but most of these reports used the percutaneous transhepatic approach.

CONCLUSION

In this paper, we describe the second reported case in English literature of a novel endoscopic technique using a combination of metallic coil embolization and N-butyl cyanoacrylate in a patient with major bile leak who was not a candidate for surgery as well as a third report of the late complication of coil migration to the common bile duct.