Supportive interventional radiology for bile leak after hepatectomy and postoperative biliary infection

Abstract

Herein, we present the case of three patients with bile leak after hepatectomy and postoperative biliary infection who were treated with interventional radiology (IVR). Case 1 was a patient with bile leak at the origin of the anterior segmental bile duct after hepatectomy. Endoscopic biliary drainage could not be inserted owing to large abscess formation. Therefore, a percutaneous drainage tube was inserted into the injured bile duct, after which an endoscopic biliary stent (EBS) could be inserted. Case 2 was a patient with bile leak after hepatectomy. An EBS could not be inserted owing to stenosis at the origin of the B5 biliary branch. Therefore, percutaneous biliary drainage tubes were inserted both upstream and downstream, after which an EBS could be inserted. Case 3 was a patients who developed liver abscess and severe biliary infection owing to stenosis of the right hepatic duct after hepaticojejunostomy. Percutaneous posterior biliary duct drainage was performed. Double balloon endoscopic biliary drainage tube could not be inserted. Therefore, PTBD support was performed using a guidewire support, thereby allowing insertion of the EBS. Furthermore, EBS could be inserted precisely and safely using IVR support.