Traumatic biliary fistula with bile duct disconnection

Area of Science:

• Gastroenterology and Hepatology
• Interventional Radiology
• Endoscopic Surgery

Background:

• Biliary tract injuries can lead to significant morbidity.
• Complex bile duct strictures and disconnections pose therapeutic challenges.
• Current management often involves complex surgical reconstructions or prolonged stenting.

Observation:

• A 43-year-old male presented with abdominal pain post-accident.
• CT revealed fluid collections; CT-guided drainage provided no relief.
• MRCP demonstrated common bile duct stricture and disconnection.
• Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dislocation and disconnection.

Findings:

• A novel endoscopic technique was employed using balloon dilation, contrast injection, and specialized guidewires.
• The procedure aimed to straighten, reposition, and bridge the disconnected common bile duct segments.
• The patient experienced significant symptom improvement within 3 days.
• Biliary stent removal after 11 months confirmed successful long-term outcome with complete pain resolution.

Implications:

• This case highlights the potential of advanced endoscopic retrograde cholangiopancreatography (ERCP) techniques for managing complex biliary tract disruptions.
• The described method offers a less invasive alternative to traditional surgery for specific bile duct injuries.
• Further research is warranted to evaluate the broader applicability and long-term efficacy of this technique in similar cases.