Abstract
A 33-year-old man complaining of lumbago and right hypochondralgia was referred to our hospital with the diagnosis of descending colon cancer and multiple hepatic metastases. After five courses of chemotherapy with FOLFOX4, descending colectomy and partial hepatectomy were performed. After the operation, a biliary fistula developed and percutaneous drainage and ENBD were done. However, these treatments were unsuccessful and recurrence to the remnant liver was identified. Following three courses of FOLFOX4 regimen and at the ninth month after the operation, extended left lobectomy of liver + partial resection of caudate lobe + anastomosis between the right hepatic duct and the jejunum were performed, and direct closure of the fistula with coverage using the greater omentum was done for the biliary fistula. However, bile leakage persisted and new bile leakage appeared from the surgical stump of the liver, for that percutaneous abdominal drainage was performed. On the 117th day after rehepatectomy, bile juice like sputum due to bronchobiliary fistula was confirmed. To perform biliary drainage, jejunostomy was created on the blind loop of the jejunum which was used for the anastomosis between the bile duct and the jejunum and endoscopic biliary drainage via the jejunostoma was performed. His bronchobiliary fistula was cured. The patient was discharged from the hospital on the 88th day after the jejunostomy.
