A Case of Disconnection Biliary Fistula after Hepatectomy Cured by Histoacryl^® Infusion

Abstract

A 75-year-old man underwent left hepatectomy for portal tumor embolism. A biliary disconnection fistula was diagnosed after hepatectomy, because the drainage from the drain placed at the cut surface changed to bile on postoperative day 5, and infusion of contrast agent to the drain showed the bile duct of the caudate lobe. Infusion of contrast agent to the drain showed the drain fistula connected to the duodenal cap. Upper gastrointestinal endoscopy showed a duodenal ulcer (A1 Stage). Proton pump-inhibitor treatment cured the duodenal ulcer, but the drain fistula connected to the duodenal cap remained. Histoacryl^® 0.4 ml + lipiodol 1 ml were infused from the duodenal ulcer on postoperative day 55. The next day, the connection between the drain fistula and the duodenal cap was closed. Infusion of contrast agent into the drain did not show the bile duct of the caudate lobe. The drain was pulled out because the drainage from the drain was decreasing. Infusion of histoacryl to the disconnected bile duct was minimally invasive, and it may be effective therapy for biliary disconnection fistulae after hepatectomy.