Minimally invasive management of a post-cholecystectomy bile leak using a microvascular plug

Bouveret syndrome is a rare form of gallstone ileus in which a gallstone causes gastric outlet obstruction via a cholecystoenteric fistula. We present the case of an elderly patient who underwent emergency surgery due to clinical signs of gastric outlet obstruction. Intraoperatively, a large gallstone was identified and removed from the duodenum. A subtotal cholecystectomy was performed, during which the identification of the course of the cystic duct was limited due to considerable inflammatory changes. In the early postoperative period, bile-stained output from the surgical drain raised suspicion of a leak from the cystic duct stump. Given the patient's clinical status and the complexity of the local anatomy with severely inflamed and fibrotic tissues in the hepatoduodenal ligament, the decision was made to proceed with percutaneous treatment. A percutaneous transhepatic biliary drainage was established, and contrast extravasation from the cystic duct remnant was confirmed via fluoroscopic cholangiography. Through the same access, a microvascular plug was successfully deployed into the cystic duct, achieving immediate cessation of bile leakage. The patient's clinical condition improved markedly, and no further intervention was required. This case demonstrates the successful off-label use of polytetrafluoroethylene-covered vascular occlusion devices in managing biliary complications.