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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
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Internal biliary drainage for isolated posterior segmental biliary obstruction: a case report
Hideki Izumi1, Hisamichi Yoshii2, Daiki Yokoyama2
1Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan. deehii@is.icc.u-tokai.ac.jp.
Journal of Medical Case Reports
|June 5, 2018
Summary
Accurate imaging is crucial for complex bile duct injury repair. This case highlights a novel technique for managing biliary obstruction after pancreaticoduodenectomy, ensuring successful stent placement and patient recovery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Interventional Radiology
Background:
- Biliary system anatomical abnormalities are detectable via MRI, yet bile duct injuries remain challenging to repair.
- Surgical complications like biliary obstruction can occur during pancreaticoduodenectomy for bile duct cancer.
Observation:
- A 72-year-old man developed isolated posterior segmental biliary obstruction post-pancreaticoduodenectomy.
- Drip infusion cholecystocholangiography-computed tomography (CT) was used to assess the relationship between the bile duct and jejunum.
- CT-guided puncture and endoscopic visualization confirmed accurate needle placement and bile duct access.
Findings:
- A novel technique involving guide wire vibration and endoscopic verification facilitated precise puncture and stent insertion.
- An 8.5-Fr pigtail catheter was successfully inserted into the elevated jejunum.
- Percutaneous placement of an uncovered metallic stent resolved the biliary obstruction without complications.
Implications:
- Accurate assessment of the positional relationship between injured bile ducts and surrounding organs is critical for successful repair.
- This minimally invasive approach offers a viable solution for managing complex biliary obstructions post-surgery.
- The technique demonstrated successful management of a challenging post-operative complication, leading to a favorable patient outcome.
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