A Case of Isolated Post-Hepatectomy Bile Leakage Cured by Biliary Stenting Using the Rendezvous Technique

Abstract

A 78-year-old man underwent left hepatic segmentectomy for hepatocellular carcinoma in segments S2 and S4 of the liver. Postoperatively, drainage of a bile-like fluid was observed from the drain on the cut surface of the liver, and drain contrast examination showed bile leakage caused by division of the bile duct in the left caudate lobe. Inflammation due to this bile leakage was also causing stenosis at the origin of the bile duct in the anterior segment, and, therefore, endoscopic biliary stenting was performed. After the abscess cavity had disappeared once the drain was replaced, anhydrous ethanol injected into the bile duct of the left caudate lobe improved the bile leakage temporarily, but inflammatory changes resulting from the ethanol injection caused the stump of the left hepatic duct to break down and develop continuity with the abscess cavity. An initial attempt to access the abscess cavity via a transpapillary approach was made, but since this proved impossible, a guidewire was inserted through the fistula for the drain in the cut surface of the liver and led from the stump of the left hepatic duct to the common bile duct and the duodenal papilla ; it was then grasped endoscopically from inside the duodenum, and biliary stenting was performed using the rendezvous technique. The treatment of a patient with isolated bile leakage in whom the fistula for the drain inserted during surgery was used to enable internal biliary drainage using the rendezvous technique was described.