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Portobiliary fistula: successful transcatheter treatment with embolisation coils
Jendana Chanyaputhipong, Richard Hoau Gong Lo1, Bien Soo Tan1
1Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608. richard.lo.h.g@sgh.com.sg.
Insights
A rare portobiliary fistula developed after percutaneous transhepatic biliary drainage in a patient with hepatitis B liver cirrhosis. This case highlights successful treatment using embolisation coils, preserving vital blood vessels and bile ducts.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Radiology
- Surgical Oncology
Background:
- Portobiliary fistula is an uncommon complication of percutaneous transhepatic biliary drainage (PTBD), potentially leading to hemobilia.
- Hepatitis B liver cirrhosis presents unique challenges in managing biliary interventions.
- Gastrointestinal stromal tumors (GISTs) of the duodenum require complex surgical and interventional management.
Abstract:
Although portobiliary fistula is a recognised complication of percutaneous transhepatic biliary drainage, it is extremely uncommon and can result in haemobilia. Herein, we present a case of complicated transhepatic biliary drainage catheter insertion in a patient with underlying hepatitis B liver cirrhosis, which resulted in a portobiliary fistula. The patient had a preoperative transhepatic biliary drainage procedure done prior to a Whipple's operation for a large, obstructive, gastrointestinal stromal tumour of the duodenum. To the best of our knowledge, this is the first case in the English medical literature reporting the successful treatment of portobiliary fistula by embolisation of its tract with embolisation coils, without compromising the portal vein or bile ducts.
